Nonventilatory strategies for patients with life-threatening 2009 H1N1 influenza and severe respiratory failure.
Severe respiratory failure (including acute lung injury and acute respiratory distress syndrome) caused by 2009 H1N1 influenza infection has been reported worldwide. Refractory hypoxemia is a common finding in these patients and can be challenging to manage. This review focuses on nonventilatory strategies in the advanced treatment of severe respiratory failure and refractory hypoxemia such as that seen in patients with severe acute respiratory distress syndrome attributable to 2009 H1N1 influenza. Specific modalities covered include conservative fluid management, prone positioning, inhaled nitric oxide, inhaled vasodilatory prostaglandins, and extracorporeal membrane oxygenation and life support. Pharmacologic strategies (including steroids) investigated for the treatment of severe respiratory failure are also reviewed.
Napolitano
Lena M
LM
Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA. lenan@med.umich.edu
Park
Pauline K
PK
Raghavendran
Krishnan
K
Bartlett
Robert H
RH
D055371:Acute Lung Injury / Q000209:etiology / Q000628:therapy*; D000280:Administration, Inhalation; D015199:Extracorporeal Membrane Oxygenation; D005440:Fluid Therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications*; D009569:Nitric Oxide / Q000627:therapeutic use; D016684:Prone Position; D011453:Prostaglandins / Q000627:therapeutic use; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*
D011453:Prostaglandins; D009569:Nitric Oxide