title: Management of acute respiratory complications from influenza A (H1N1) infection: experience of a tertiary-level Intensive Care Unit.
abstract: The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness.
  
  
  
  We describe the clinical profiles of critically ill patients with severe complications due to microbiologically confirmed pandemic influenza A (H1N1) infection admitted to a medical ICU in Monza, Italy, over a 6-month period.
  
  
  
  From August 2009 to January 2010, 19 patients (13 adults and 6 children) required ICU admission. Nine subjects were referred to our hospital from other ICUs. In all patients, with the exception of a case of severe septic shock, the cause of ICU admission was acute respiratory failure. Other nonpulmonary organ failures were common. A trial of non-invasive ventilation was attempted in 13 cases and was successful in four of them. The majority of the patients required invasive mechanical ventilation. In the 7 most severely hypoxemic patients, we applied veno-venous ECLS, with a very high rate of success. The median ICU stay was 9 days (range 1-78 days). Sixteen out of 19 (84%) patients survived.
  
  
  
  In the majority of our patients, critical illness caused by pandemic influenza A (H1N1) was associated with severe hypoxemia, multiple organ failure, requirement for mechanical ventilation and frequent use of rescue therapies and ECLS support.
authors: Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy. jaku71@gmail.com
authors: G
authors: G
authors: Grasselli
authors: M
authors: M
authors: Bombino
authors: N
authors: N
authors: Patroniti
authors: G
authors: G
authors: Foti
authors: A
authors: A
authors: Benini
authors: C
authors: C
authors: Abbruzzese
authors: R
authors: R
authors: Fumagalli
authors: A
authors: A
authors: Pesenti
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000628:therapy*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D055815:Young Adult