Wieruszewski PM, Linn DD. Contemporary management of severe influenza disease in the intensive care unit.
J Crit Care 2018;
48:48-55. [PMID:
30172033 PMCID:
PMC7127549 DOI:
10.1016/j.jcrc.2018.08.015]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 08/02/2018] [Accepted: 08/15/2018] [Indexed: 01/12/2023]
Abstract
Despite continued efforts to optimize vaccination composition, severe influenza disease requiring intensive care unit (ICU) admission remains a clinical issue. Influenza epidemics and pandemics worldwide continue to challenge clinicians with managing infected patients requiring ICU care. While routine use of antiviral therapy is deployed in ambulatory outpatients, their use in the ICU in patients with hypoxemic respiratory failure is less well established. Additionally, these therapies primarily target the neuraminidase protein, while contemporary research is increasingly demonstrating potential therapeutic benefits of targeting the hemagglutinin protein. These data have given rise to a growing interest in the use of immune modulating therapies for treatment of severe influenza. Additionally, pandemic outbreaks have revealed the growing need for salvage management, wherein lies the potential role for venovenous extracorporeal membrane oxygenation therapy in refractory respiratory failure. In this report, we review the contemporary ICU care of the severe influenza patient.
Influenza remains a challenging disease in the intensive care unit.
Early anti-viral therapy may be associated with reduced mortality in the critically ill.
Evidence surrounding the use of immune modulating therapies is growing.
Corticosteroids are harmful and should not be used during the treatment of influenza.
Additional research and commercial optimization is needed for widespread application of immune therapies.
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