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Extracorporeal Membrane Oxygenation for Severe Refractory Respiratory Failure Secondary to 2009 H1N1 Influenza A.
MedLine Citation:
PMID:  21352668     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Respiratory failure and acute respiratory distress syndrome (ARDS) secondary to H1N1 influenza infection is a source of significant morbidity and mortality, causing over 265,000 hospitalizations in the United States in 2009. During the H1N1 pandemic, up to 31% of patients infected with H1N1 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: After Institutional Review Board approval, we retrospectively reviewed the medical records of all patients with refractory hypoxemia due to H1N1 influenza infection who were treated with ECMO in our institution. RESULTS: Seven patients with H1N1 influenza infection were treated with ECMO in the Pediatric Intensive Care Unit (PICU), with 71% surviving to hospital discharge. The mean age in this series was 21 years, and four (57%) of the patients were female. Six patients (86%) had at least one co-morbid condition, six (86%) were mechanically ventilated, and one (14%) was in shock at the time of PICU admission. All seven patients were treated with oral oseltamivir, high frequency oscillatory ventilation and inhaled nitric oxide prior to initiation of ECMO. Additionally, five (71%) were treated with intravenous steroids during their course, and two (29%) were treated with compassionate use intravenous zanamivir. The mean duration of pre-ECMO ventilation was 8.7 days (range: 14 hrs - 25 days), and mean Oxygenation Index (OI) was 50 (range: 26 - 51) at the time of ECMO cannulation. Six patients (86%) were treated with venovenous ECMO, and one (14%) was treated with venoarterial ECMO. The mean duration of ECMO was 430 hours (range: 192 - 890 hrs). CONCLUSIONS: This series supports the notion that ECMO is a viable treatment option for refractory hypoxemia secondary to H1N1 influenza infection in both pediatric and adult patients.
Authors:
David A Turner; Kyle J Rehder; Stacey L Peterson-Carmichael; Caroline P Ozment; Mashael S Al-Hegelan; Walter L Williford; Michelle A Peters; Paul W Noble; Ira M Cheifetz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-21
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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