Article

Avian influenza (H5N1): implications for intensive care

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, 00, Hong Kong
Intensive Care Medicine (Impact Factor: 5.54). 07/2006; 32(6):823-9. DOI: 10.1007/s00134-006-0148-z
Source: PubMed

ABSTRACT 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.

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    • "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 [17]. "
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    • "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 [69]. "
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