Management of acute respiratory complications from influenza A (H1N1) infection: experience of a tertiary-level Intensive Care Unit

Minerva Anestesiol. 2011 Sep;77(9):884-91.


Background: The novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness.

Methods: We describe the clinical profiles of critically ill patients with severe complications due to microbiologically confirmed pandemic influenza A (H1N1) infection admitted to a medical ICU in Monza, Italy, over a 6-month period.

Results: From August 2009 to January 2010, 19 patients (13 adults and 6 children) required ICU admission. Nine subjects were referred to our hospital from other ICUs. In all patients, with the exception of a case of severe septic shock, the cause of ICU admission was acute respiratory failure. Other nonpulmonary organ failures were common. A trial of non-invasive ventilation was attempted in 13 cases and was successful in four of them. The majority of the patients required invasive mechanical ventilation. In the 7 most severely hypoxemic patients, we applied veno-venous ECLS, with a very high rate of success. The median ICU stay was 9 days (range 1-78 days). Sixteen out of 19 (84%) patients survived.

Conclusion: In the majority of our patients, critical illness caused by pandemic influenza A (H1N1) was associated with severe hypoxemia, multiple organ failure, requirement for mechanical ventilation and frequent use of rescue therapies and ECLS support.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Child
  • Critical Care*
  • Extracorporeal Membrane Oxygenation
  • Female
  • Humans
  • Influenza A Virus, H1N1 Subtype*
  • Influenza, Human / complications*
  • Influenza, Human / therapy*
  • Italy
  • Male
  • Middle Aged
  • Pulmonary Gas Exchange
  • Respiration, Artificial
  • Respiratory Function Tests
  • Respiratory Insufficiency / etiology*
  • Respiratory Insufficiency / therapy*
  • Young Adult