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Document Details : Title: Severe influenza A(H1N1)2009 infection: A single centre experience and review of the literature Author(s): VAN IERSSEL SH, IEVEN M, JORENS PG Journal: Acta Clinica Belgica Volume: 67 Issue: 1 Date: 2012 Pages: 1-6 DOI: 10.2143/ACB.67.1.1003087 Abstract : The first influenza pandemic of the 21st century started in April 2009 with an outbreak of swine origin infl uenza A(H1N1)2009 in Mexico and the United States. While generally a mild disease aff ecting mostly schoolaged children and young adults, most attention went to severe cases of pneumonia in young previously healthy individuals or individuals belonging to a risk group. In this article we review the literature on the presentation and management of severe cases of influenza A(H1N1)2009 in the intensive care unit (ICU), and describe our own experience in a tertiary referral centre with ECMO facilities. Pregnant women and (bone marrow) transplant patients are two known risk groups for severe influenza escribed more thoroughly in this paper. These severely ill patients are characterized by respiratory failure, resulting often in the need of mechanical ventilation. As Oseltamivir resistance remains low up till now, early antiviral therapy with Oseltamivir is warranted in these cases. Despite pharmacological and ventilator management, refractory hypoxaemia is described frequently in these patients, with need for rescue therapies like nitric oxide inhalation, high frequency ventilation, and extracorporeal membrane oxygenation. The value of the use of corticosteroids is under discussion. Despite advances in management strategies, mortality and morbidity in these severe cases remains high. In the fi rst influenza season after the pandemic, winter 2010/2011, influenza A(H1N1)2009 is the major infl uenza A strain in Europe, resulting in reports with increased mortality and morbidity compared to pre-pandemic seasonal infl uenza. “Continuing vigilance for severe infl uenza in patients not belonging to the classical infl uenza risk group might still be warranted for the upcoming infl uenza season. |
