title: Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: results of an Italian referral ECMO center.
abstract: BACKGROUND
  Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.
  
  
  METHODS
  Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.
  
  
  RESULTS
  A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%.
  
  
  CONCLUSIONS
  In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.
authors.affiliation: Anesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cianchi
authors.forename: Manuela
authors.initials: M
authors.lastname: Bonizzoli
authors.forename: Andrea
authors.initials: A
authors.lastname: Pasquini
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zagli
authors.forename: Marco
authors.initials: M
authors.lastname: Ciapetti
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
authors.forename: Stefano
authors.initials: S
authors.lastname: Batacchi
authors.forename: Simona
authors.initials: S
authors.lastname: Biondi
authors.forename: Pasquale
authors.initials: P
authors.lastname: Bernardo
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Valtere
authors.initials: V
authors.lastname: Giovannini
authors.forename: Alberta
authors.initials: A
authors.lastname: Azzi
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gensini
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
mesh_terms: D000293:Adolescent; D000328:Adult; D018893:Bronchoalveolar Lavage; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis / Q000628:therapy*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy* / Q000821:virology*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D016896:Treatment Outcome; D014463:Ultrasonography