As influenza A/H5N1 spreads around the globe the risk of an epidemic increases.
Review of the cases of influenza A/H5N1 reported to date demonstrates that it causes a severe illness, with a high proportion of patients (63%) requiring advanced organ support. Of these approx. 68% develop multiorgan failure, at least 54% develop acute respiratory distress syndrome, and 90% die. Disease progression is rapid, with a median time from presentation to hospital to requirement for advanced organ support of only 2 days.
The infectious nature, severity and clinical manifestations of the disease and its potential for pandemic spread have considerable implications for intensive care in terms of infection control, patient management, staff morale and intensive care expansion.
"In addition, positive end expiratory pressure and fraction of inspired oxygen are adjusted to maintain a partial pressure of oxygen of 55 mm Hg to 80 mm Hg. Of particular note is the significant incidence of pneumothorax reported in patients with AI H5N1, which may necessitate a cautious approach to lung recruitment maneuvers . "
[Show abstract][Hide abstract] ABSTRACT: With the increasing threat of pandemic influenza and catastrophic bioterrorism, it is important for intensive care providers to be prepared to meet the challenge of large-scale airborne epidemics causing mass casualty respiratory failure. The severe acute respiratory syndrome outbreak exposed the vulnerability of health care workers and highlighted the importance of establishing stringent infection control and crisis management protocols. Patients who have acute lung injury and acute respiratory distress syndrome who require mechanical ventilation should receive a lung protective, low tidal volume strategy. Controversy remains regarding the use of high-frequency oscillatory ventilation and noninvasive positive pressure ventilation. Standard, contact, and airborne precautions should be instituted in intensive care units, with special care taken when aerosol-generating procedures are performed.
Clinics in Chest Medicine 07/2008; 29(2):323-8, vii. DOI:10.1016/j.ccm.2008.01.001 · 2.07 Impact Factor
"Gastrointestinal symptoms, as seen with HPAI H5N1, and reports of primary influenza pneumonia and development of ARDS are also more common with avian influenza A infections [65,67,69]. Finally, the rapid progression to multi-organ failure and eventually death occurs at a much higher rate with avian influenza A infections . "
[Show abstract][Hide abstract] ABSTRACT: Influenza A viruses have a wide host range for infection, from wild waterfowl to poultry to humans. Recently, the cross-species transmission of avian influenza A, particularly subtype H5N1, has highlighted the importance of the non-human subtypes and their incidence in the human population has increased over the past decade. During cross-species transmission, human disease can range from the asymptomatic to mild conjunctivitis to fulminant pneumonia and death. With these cases, however, the risk for genetic change and development of a novel virus increases, heightening the need for public health and hospital measures. This review discusses the epidemiology, host range, human disease, outcome, treatment, and prevention of cross-transmission of avian influenza A into humans.
[Show abstract][Hide abstract] ABSTRACT: Pandemic influenza: intensive care management of adults and children The clinical course of pandemic H1N1 infection has been quite different from seasonal influenza in- fection. It has mostly affected young and healthy population. Depending on outbreak's course till to- day and the previous outbreaks 12-30% of the population was expected to become ill and among them 4% was expected to be hospitalised throughout the pandemic. It was estimated for all inten- sive care unit (ICU) beds to be occupied with patients infected with H1N1 virus in the first period of the pandemic. Fortunately, without being confronted with this situation, pandemic has been mil- der than expected. Any how, in southern hemisphere as in Australia and New Zeland which were
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