Abstract
Background: The recent ERS/ESICM guidelines do not recommend the use of non-invasive ventilation (NIV) in patients with severe pneumonia caused by H1N1 infection.
Methods: We retrospectively reviewed the clinical data of 9 consecutive patients with acute respiratory failure due to H1N1 virus, admitted to the Emergency Department of Fondazione IRCCS Ca' Granda Policlinico (Milan, Italy), between January 1 and February 20, 2011.
Results: Patients were predominantly male (66%), mean age was 55 years (range 34-79).7/9 patients had one or more risk factors for severe H1N1 infection: obesity, chronic pulmonary disease, onco-haematologic disease, age ≥65 years. All patients presented with high fever (>38°C), cough, dyspnea and multifocal bilateral consolidations on chest X ray. 6/9 patients developed ALI, 2/9 patients presented with ARDS. All patients received oseltamivir and empirical antibiotic therapy. 7/9 patients were immediately treated with NIV (6 CPAP, 1 BiLevel). 5/7 patients developed severe sepsis; no patients showed signs of septic shock or needed inotropic support. One patient needed endotracheal intubation. Only one patient died for acute respiratory failure due to nosocomial infection, all the others were discharged after a mean of 17 days (range 4-34).
Conclusions: NIV was successfully applied in the majority of patients (6/7), and only one patient needed endotracheal intubation. Our data suggest that in particular settings with staff experienced with NIV, high monitoring level and rapid access to intubation and ICU, early NIV could be an option to improve oxygenation in acute respiratory failure due to Influenza A H1N1 infection.
- © 2011 ERS