As the spring/summer travel season begins, it is predicted that we will see additional cases of H1N1
The most common presentation requiring ICU admission to date has been a viral pneumonitis
As highlighted in previous pearls, the hallmark of disease has been refractory hypoxemia requiring mechanical ventilation in about 85% of patients.
Current recommendations for H1N1 respiratory failure:
Consider early intubation
Noninvasive ventilation has been unsuccessful in most and should generally be avoided
Low tidal volume settings (6 ml/kg) with PEEP based on FiO2 to maintain SpO2 > 88% and plateau pressure < 35 cm H2O
Although there is no proven mortality benefit to rescue therapies such as recruitment maneuvers, neuromuscular blockade, and prone ventilation, these can be considered in discussion with your intensivist.
References
Ramsey CD, Funk D, Miller RR, Kumar A. Ventilator management for hypoxemic respiratory failure attributable to H1N1 novel swing origin influenza virus. Crit Care Med 2010; 38(Suppl):e58-65.
