[The lung protection strategy under the support of extracorporeal membrane oxygenation in patients suffering from influenza A H1N1].
OBJECTIVE
To study the effect of extracorporeal membrane oxygenation (ECMO) in patients suffering from severe pneumonia complicating influenza A H1N1 by putting lungs in rest to protect the latter.


METHODS
Five patients with severe pneumonia following influenza A H1N1 were treated with ECMO and different modes of mechanical ventilation at the same time. Two patients died, both of them received synchronized intermittent mandatory ventilation (SIMV) and bi-level positive airway pressure (BiPAP) modes, with airway pressure release ventilation (APRV) to control lung expansion with expansion pressure 40 cm H(2)O (1 cm H(2)O=0.098 kPa). In 3 survivors, the strategy of lung rest was performed by giving an optimized positive end expiratory pressure (PEEP) with an optimal compliance by gradually elevation of PEEP, and high-level pressure (Phigh) at 20 cm H(2)O by application of BiPAP mode.


RESULTS
One patient died due to lung damage and repeated spontaneous pneumothorax and sepsis; 1 patient died due to multiple organ dysfunction syndrome. Three patients recovered after following the strategy of lung rest.


CONCLUSIONS
When ECMO is used for severe pneumonia complicating influenza A H1N1, prognosis can be obviously improved, with decrease in the occurrence of lung damage through the protection strategy of lung rest.
Xu
Lei
L
Department of Critical Care Medicine, the Third Central Hospital of Tianjin, Tianjin 300170, China.
Du
Zhong-zhen
ZZ
Gao
Xin-jing
XJ
Qin
Ying-zhi
YZ
Li
Zhi-bo
ZB
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011024:Pneumonia, Viral / Q000628:therapy* / Q000821:virology; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control; D055815:Young Adult