H1N1 infection and acute respiratory failure: can we give non-invasive ventilation a chance?

Early non-invasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia

BACKGROUND AND AIMS

Severe community-acquired pneumonia (sCAP) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of sCAP consists of antibiotic therapy and ventilator support. The use of invasive ventilation causes several complications as does admission to ICU. For this reason, non-invasive ventilation (NIV) has been used for acute respiratory failure to avoid endotracheal intubation. However, few studies have currently assessed the usefulness of NIV in sCAP.

METHODS

We prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (PaO2/FiO2) <250]. We defined successful NIV as avoidance of intubation and the achievement of PaO2/FiO2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses.

RESULTS

NIV failed in 32 patients (25.1%). Higher chest X-ray score at admission, chest X-ray worsening, and a lower PaO2/FiO2 and higher alveolar-arteriolar gradient (A-aDO2) after 1 h of NIV all independently predicted NIV failure. Higher lactate dehydrogenase and confusion, elevated blood urea, respiratory rate, blood pressure plus age ≥65 years at admission, higher A-aDO2, respiratory rate and lower PaO2/FiO2 after 1 h of NIV and intubation rate were directly related to hospital mortality.

CONCLUSIONS

Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory.

Pandemic Influenza Management and Control Policies: Hospital Coordination During an Influenza Pandemic

Since its initial outbreak in April 2009, the pandemic H1N1 virus has posed a challenge to health systems around the world, compelling them to make available the benefits of scientific and medical progress to the entire population. Some of the most significant demands were access to early diagnostics, vaccines, and antiviral treatments as well as the responsiveness of hospital care, particularly in seriously ill patients who required attention in intensive care units (ICUs). The increased demand of medical care during an influenza pandemic is a heavy burden for any health system as it is added to the regular demand for heath care, which should not become paralyzed [1].