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Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A.
Respir Care. 2011 Jul; 56(7):941-6.RC

Abstract

BACKGROUND

Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of the H1N1 patients required intensive care unit admission, and many were refractory to maximal conventional therapies. These most critically ill patients may require extracorporeal membrane oxygenation (ECMO) for survival.

METHODS

We retrospectively reviewed the medical records of the 7 patients with refractory hypoxemia due to H1N1 influenza who were treated with ECMO in our pediatric intensive care unit.

RESULTS

Five of the 7 patients survived to hospital discharge. The cohort's mean age was 21 years, and 4 were female. At admission to the pediatric intensive care unit, 6 had at least one comorbid condition, 6 were mechanically ventilated, and one was in shock. All 7 patients were treated with oral oseltamivir, high-frequency oscillatory ventilation, and inhaled nitric oxide prior to ECMO. Five received intravenous steroids, and 2 were treated with compassionate-use intravenous zanamivir. The mean duration of pre-ECMO ventilation was 8.7 days (range 14 h to 25 d). Mean oxygenation index was 50 (range 26-73) at ECMO cannulation. Six received venovenous ECMO, and one received venoarterial ECMO. The mean duration of ECMO was 432 hours (range 192-890 h).

CONCLUSIONS

This series suggests that ECMO is a viable treatment for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients.

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Authors+Show Affiliations

Turner DA
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA. david.turner@duke.edu
Rehder KJ
No affiliation info available
Peterson-Carmichael SL
No affiliation info available
Ozment CP
No affiliation info available
Al-Hegelan MS
No affiliation info available
Williford WL
No affiliation info available
Peters MA
No affiliation info available
Noble PW
No affiliation info available
Cheifetz IM
No affiliation info available

MeSH

AdolescentAdultAntiviral AgentsChildCritical IllnessExtracorporeal Membrane OxygenationFemaleHumansInfluenza A Virus, H1N1 SubtypeInfluenza, HumanIntensive Care Units, PediatricMaleOseltamivirRespiratory InsufficiencyRetrospective StudiesYoung AdultZanamivir

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21352668

Citation

Turner, David A., et al. "Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A." Respiratory Care, vol. 56, no. 7, 2011, pp. 941-6.
Turner DA, Rehder KJ, Peterson-Carmichael SL, et al. Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A. Respir Care. 2011;56(7):941-6.
Turner, D. A., Rehder, K. J., Peterson-Carmichael, S. L., Ozment, C. P., Al-Hegelan, M. S., Williford, W. L., Peters, M. A., Noble, P. W., & Cheifetz, I. M. (2011). Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A. Respiratory Care, 56(7), 941-6. https://doi.org/10.4187/respcare.01066
Turner DA, et al. Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A. Respir Care. 2011;56(7):941-6. PubMed PMID: 21352668.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal membrane oxygenation for severe refractory respiratory failure secondary to 2009 H1N1 influenza A. AU - Turner,David A, AU - Rehder,Kyle J, AU - Peterson-Carmichael,Stacey L, AU - Ozment,Caroline P, AU - Al-Hegelan,Mashael S, AU - Williford,Walter L, AU - Peters,Michelle A, AU - Noble,Paul W, AU - Cheifetz,Ira M, Y1 - 2011/02/21/ PY - 2011/3/1/entrez PY - 2011/3/1/pubmed PY - 2011/9/29/medline SP - 941 EP - 6 JF - Respiratory care JO - Respir Care VL - 56 IS - 7 N2 - BACKGROUND: Respiratory failure and acute respiratory distress syndrome secondary to H1N1 influenza infection is a source of substantial morbidity and mortality, having caused over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of the H1N1 patients required intensive care unit admission, and many were refractory to maximal conventional therapies. These most critically ill patients may require extracorporeal membrane oxygenation (ECMO) for survival. METHODS: We retrospectively reviewed the medical records of the 7 patients with refractory hypoxemia due to H1N1 influenza who were treated with ECMO in our pediatric intensive care unit. RESULTS: Five of the 7 patients survived to hospital discharge. The cohort's mean age was 21 years, and 4 were female. At admission to the pediatric intensive care unit, 6 had at least one comorbid condition, 6 were mechanically ventilated, and one was in shock. All 7 patients were treated with oral oseltamivir, high-frequency oscillatory ventilation, and inhaled nitric oxide prior to ECMO. Five received intravenous steroids, and 2 were treated with compassionate-use intravenous zanamivir. The mean duration of pre-ECMO ventilation was 8.7 days (range 14 h to 25 d). Mean oxygenation index was 50 (range 26-73) at ECMO cannulation. Six received venovenous ECMO, and one received venoarterial ECMO. The mean duration of ECMO was 432 hours (range 192-890 h). CONCLUSIONS: This series suggests that ECMO is a viable treatment for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients. SN - 0020-1324 UR - https://www.unboundmedicine.com/medline/citation/21352668/Extracorporeal_membrane_oxygenation_for_severe_refractory_respiratory_failure_secondary_to_2009_H1N1_influenza_A_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&pmid=21352668 DB - PRIME DP - Unbound Medicine ER -