title: Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome.
abstract: OBJECTIVE
  To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).
  
  
  METHODS
  All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO2 of 0.6 or less and positive end-expiratory pressure <10 cm of H2 O.
  
  
  RESULTS
  At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6-8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO2 /FiO2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days.
  
  
  CONCLUSIONS
  Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Pradeep M
authors.initials: PM
authors.lastname: Venkategowda
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: S Manimala
authors.initials: SM
authors.lastname: Rao
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Yogesh R
authors.initials: YR
authors.lastname: Harde
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Mithilesh K
authors.initials: MK
authors.lastname: Raut
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Dnyaneshwar P
authors.initials: DP
authors.lastname: Mutkule
authors.affiliation: Department of Critical Care Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Kartik
authors.initials: K
authors.lastname: Munta
authors.affiliation: Department of General Medicine, Yashoda Multi-speciality Hospital, Somajiguda, Hyderabad, Telangana, India.
authors.forename: Mallela V
authors.initials: MV
authors.lastname: Rao
keywords: Influenza A virus; inverse ratio ventilation; pressure control ventilation; prone position; severe acute respiratory distress syndrome