Semin Respir Crit Care Med 2011; 32(4): 400-408
DOI: 10.1055/s-0031-1283280
© Thieme Medical Publishers

H1N1 Influenza: Critical Care Aspects

Glen P. Westall1 , Miranda Paraskeva1
  • 1Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
Further Information

Publication History

Publication Date:
19 August 2011 (online)

ABSTRACT

During the Northern Hemisphere spring of 2009, a novel H1N1 influenza A virus emerged in Mexico, causing widespread human infection and acute critical respiratory illness. The 2009 H1N1 virus spread initially to the United States and Canada, with subsequent rapid global dissemination, leading the World Health Organization (WHO) to declare “a public health emergency of international concern” in April 2009, and upgrading the viral threat to pandemic status in June 2009. Despite initial fears, the severity of the 2009 H1N1 pandemic overall did not differ significantly from that of seasonal influenza. However, the demographics of those at risk of severe illness did differ (affecting children and young adults, rather than the very young and the very old). The 2009 H1N1 pandemic led to rapid implementation of health care initiatives, including the provision of critical care services, to limit the effect of the influenza outbreak on the community. This review focuses on the critical care response to the H1N1 pandemic and examines whether the implementation of critical care services as planned a priori matched the reality of the clinical workload and the patient burden that transpired during the 2009 H1N1 influenza pandemic.

REFERENCES

  • 1 Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S INER Working Group on Influenza et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico.  N Engl J Med. 2009;  361 (7) 680-689
  • 2 Garten R J, Davis C T, Russell C A et al.. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans.  Science. 2009;  325 (5937) 197-201
  • 3 Murray J F, Matthay M A, Luce J M, Flick M R. An expanded definition of the adult respiratory distress syndrome.  Am Rev Respir Dis. 1988;  138 (3) 720-723
  • 4 de Castro I F, Guzmán-Fulgencio M, García-Alvarez M, Resino S. First evidence of a pro-inflammatory response to severe infection with influenza virus H1N1.  Crit Care. 2010;  14 (1) 115
  • 5 Maines T R, Jayaraman A, Belser J A et al.. Transmission and pathogenesis of swine-origin 2009 A(H1N1) influenza viruses in ferrets and mice.  Science. 2009;  325 (5939) 484-487
  • 6 Itoh Y, Shinya K, Kiso M et al.. In vitro and in vivo characterization of new swine-origin H1N1 influenza viruses.  Nature. 2009;  460 (7258) 1021-1025
  • 7 Munster V J, de Wit E, van den Brand J M et al.. Pathogenesis and transmission of swine-origin 2009 A(H1N1) influenza virus in ferrets.  Science. 2009;  325 (5939) 481-483
  • 8 Khan K, Arino J, Hu W et al.. Spread of a novel influenza A (H1N1) virus via global airline transportation.  N Engl J Med. 2009;  361 (2) 212-214
  • 9 WHO flu update. 2010. http://wwwwhoint/csr/don/2010_06_04/en/indexhtml Accessed June 5, 2010
  • 10 Chowell G, Bertozzi S M, Colchero M A et al.. Severe respiratory disease concurrent with the circulation of H1N1 influenza.  N Engl J Med. 2009;  361 (7) 674-679
  • 11 Simonsen L, Olson D R, Viboud C, Taylor R J, Miller M A, Reichert T. Pandemic influenza and mortality: past evidence and projection for the future. In: Knobler S L, Mack A, Mahmoud A, Lemon S M, eds. The Threat of Pandemic Influenza: Are We Ready?. Washington, DC: National Academies Press; 2005: 89-114
  • 12 Transmission dynamics and impact of pandemic influenza A (H1N1) 2009 virus.  Wkly Epidemiol Rec. 2009;  84 (46) 481-484
  • 13 Louie J K, Acosta M, Winter K California Pandemic (H1N1) Working Group et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California.  JAMA. 2009;  302 (17) 1896-1902
  • 14 Francis T. On the doctrine of original antigenic sin.  Proc Am Philos Soc. 1960;  104 572-578
  • 15 Jain S, Kamimoto L, Bramley A M 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.  N Engl J Med. 2009;  361 (20) 1935-1944
  • 16 Domínguez-Cherit G, Lapinsky S E, Macias A E et al.. Critically Ill patients with 2009 influenza A(H1N1) in Mexico.  JAMA. 2009;  302 (17) 1880-1887
  • 17 Webb S A, Pettilä V, Seppelt I ANZIC Influenza Investigators et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand.  N Engl J Med. 2009;  361 (20) 1925-1934
  • 18 Kumar A, Zarychanski R, Pinto R Canadian Critical Care Trials Group H1N1 Collaborative et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada.  JAMA. 2009;  302 (17) 1872-1879
  • 19 Wilson N, Baker M G. The emerging influenza pandemic: estimating the case fatality ratio.  Euro Surveill. 2009;  14 (26)
  • 20 Thompson W W, Shay D K, Weintraub E et al.. Influenza-associated hospitalizations in the United States.  JAMA. 2004;  292 (11) 1333-1340
  • 21 Cao B, Li X W, Mao Y National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China.  N Engl J Med. 2009;  361 (26) 2507-2517
  • 22 Libster R, Bugna J, Coviello S et al.. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina.  N Engl J Med. 2010;  362 (1) 45-55
  • 23 Jouvet P, Hutchison J, Pinto R Canadian Critical Care Trials Group H1N1 Collaborative et al. Critical illness in children with influenza A/pH1N1 2009 infection in Canada.  Pediatr Crit Care Med. 2010;  11 (5) 603-609
  • 24 Update on oseltamivir-resistant pandemic A (H1N1) 2009 influenza virus: January 2010.  Wkly Epidemiol Rec. 2009;  85 (6) 37-40
  • 25 Miroballi Y, Baird J S, Zackai S et al.. Novel influenza A(H1N1) in a pediatric health care facility in New York City during the first wave of the 2009 pandemic.  Arch Pediatr Adolesc Med. 2010;  164 (1) 24-30
  • 26 Lister P, Reynolds F, Parslow R et al.. Swine-origin influenza virus H1N1, seasonal influenza virus, and critical illness in children.  Lancet. 2009;  374 (9690) 605-607
  • 27 Centers for Disease Control and Prevention (CDC) . Surveillance for pediatric deaths associated with 2009 pandemic influenza A (H1N1) virus infection—United States, April–August 2009.  MMWR Morb Mortal Wkly Rep. 2009;  58 (34) 941-947
  • 28 Funk D J, Siddiqui F, Wiebe K et al.. Practical lessons from the first outbreaks: clinical presentation, obstacles, and management strategies for severe pandemic (pH1N1) 2009 influenza pneumonitis.  Crit Care Med. 2010;  38 (4, Suppl) e30-e37
  • 29 Miller III R R, Markewitz B A, Rolfs R T et al.. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection.  Chest. 2010;  137 (4) 752-758
  • 30 Neuzil K M, Reed G W, Mitchel E F, Simonsen L, Griffin M R. Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women.  Am J Epidemiol. 1998;  148 (11) 1094-1102
  • 31 Lapinsky S E. H1N1 novel influenza A in pregnant and immunocompromised patients.  Crit Care Med. 2010;  38 (4, Suppl) e52-e57
  • 32 2009 H1N1 flu: international situation update. Atlanta, GA: Centers for Disease Control and Prevention; 2009. http://www.cdc.gov/h1n1flu/updates/international Accessed June 5, 2010
  • 33 Louie J K, Acosta M, Jamieson D J, Honein M A. California Pandemic (H1N1) Working Group . Severe 2009 H1N1 influenza in pregnant and postpartum women in California.  N Engl J Med. 2010;  362 (1) 27-35
  • 34 Jamieson D J, Honein M A, Rasmussen S A Novel Influenza A (H1N1) Pregnancy Working Group et al. H1N1 2009 influenza virus infection during pregnancy in the USA.  Lancet. 2009;  374 (9688) 451-458
  • 35 ANZIC Influenza Investigators and Australasian Maternity Outcomes Surveillance System . Critical illness due to 2009 A/H1N1 influenza in pregnant and postpartum women: population based cohort study.  BMJ. 2010;  340 c1279
  • 36 Flint S M, Davis J S, Su J Y et al.. Disproportionate impact of pandemic (H1N1) 2009 influenza on Indigenous people in the Top End of Australia's Northern Territory.  Med J Aust. 2010;  192 (10) 617-622
  • 37 Kunisaki K M, Janoff E N. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.  Lancet Infect Dis. 2009;  9 (8) 493-504
  • 38 Australian Health Management Plan for Pandemic Influenza 2009 (AHMPPI 2009). http://www.health.gov.au/internet/panflu/publishing.nsf/Content/resources-1#ahmppi Accessed June 5, 2010
  • 39 Australian Government Department of Health and Ageing .Australian influenza surveillance report no. 21: reporting period 26 September–2 October 2009. http://www.healthemergency.gov.au Accessed June 5, 2010
  • 40 Funk D J, Siddiqui F, Wiebe K et al.. Practical lessons from the first outbreaks: clinical presentation, obstacles, and management strategies for severe pandemic (pH1N1) 2009 influenza pneumonitis.  Crit Care Med. 2010;  38 (4, Suppl) e30-e37
  • 41 Cauchemez S, Donnelly C A, Reed C et al.. Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States.  N Engl J Med. 2009;  361 (27) 2619-2627
  • 42 Louie J K, Acosta M, Jamieson D J, Honein M A. California Pandemic (H1N1) Working Group . Severe 2009 H1N1 influenza in pregnant and postpartum women in California.  N Engl J Med. 2010;  362 (1) 27-35
  • 43 WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. Geneva, Switzerland: World Health Organization; 2010. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html Accessed June 5, 2010
  • 44 Ariano R E, Sitar D S, Zelenitsky S A et al.. Enteric absorption and pharmacokinetics of oseltamivir in critically ill patients with pandemic (H1N1) influenza.  CMAJ. 2010;  182 (4) 357-363
  • 45 Wang B, Dwyer D E, Blyth C C et al.. Detection of the rapid emergence of the H275Y mutation associated with oseltamivir resistance in severe pandemic influenza virus A/H1N1 09 infections.  Antiviral Res. 2010;  87 (1) 16-21
  • 46 Dulek D E, Williams J V, Creech C B et al.. Use of intravenous zanamivir after development of oseltamivir resistance in a critically Ill immunosuppressed child infected with 2009 pandemic influenza A (H1N1) virus.  Clin Infect Dis. 2010;  50 (11) 1493-1496
  • 47 Clinical management of human infection with pandemic (H1N1) 2009: revised guidance. Geneva, Switzerland: World Health Organization; November 2009. http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html Accessed June 5, 2010
  • 48 Danziger-Isakov L A, Husain S, Mooney M L, Hannan M M. ISHLT Infectious Diseases Council . The novel 2009 H1N1 influenza virus pandemic: unique considerations for programs in cardiothoracic transplantation.  J Heart Lung Transplant. 2009;  28 (12) 1341-1347
  • 49 Kumar D, Morris M I, Kotton C N AST Infectious Diseases Community of Practice and Transplant Infectious Diseases Section of TTS et al. Guidance on novel influenza A/H1N1 in solid organ transplant recipients.  Am J Transplant. 2010;  10 (1) 18-25
  • 50 Quispe-Laime A M, Bracco J D, Barberio P A et al.. H1N1 influenza A virus-associated acute lung injury: response to combination oseltamivir and prolonged corticosteroid treatment.  Intensive Care Med. 2010;  36 (1) 33-41
  • 51 Stockman L J, Bellamy R, Garner P. SARS: systematic review of treatment effects.  PLoS Med. 2006;  3 (9) e343
  • 52 Sprung C L, Annane D, Singer M, Cuthbertson B H, Briegel J. Steroids in patients with septic shock.  Chest. 2009;  136 (1) 323-324 author reply 324
  • 53 Wright P F, Kirkland K B, Modlin J F. When to consider the use of antibiotics in the treatment of 2009 H1N1 influenza-associated pneumonia.  N Engl J Med. 2009;  361 (24) e112
  • 54 Morens D M, Taubenberger J K, Fauci A S. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness.  J Infect Dis. 2008;  198 (7) 962-970
  • 55 Kesecioglu J, Beale R, Stewart T E et al.. Exogenous natural surfactant for treatment of acute lung injury and the acute respiratory distress syndrome.  Am J Respir Crit Care Med. 2009;  180 (10) 989-994
  • 56 Adhikari N, Burns K E, Meade M O. Pharmacologic therapies for adults with acute lung injury and acute respiratory distress syndrome.  Cochrane Database Syst Rev. 2004;  (4) CD004477
  • 57 Raghavendran K, Pryhuber G S, Chess P R, Davidson B A, Knight P R, Notter R H. Pharmacotherapy of acute lung injury and acute respiratory distress syndrome.  Curr Med Chem. 2008;  15 (19) 1911-1924
  • 58 Adhikari N K, Burns K E, Friedrich J O, Granton J T, Cook D J, Meade M O. Effect of nitric oxide on oxygenation and mortality in acute lung injury: systematic review and meta-analysis.  BMJ. 2007;  334 (7597) 779
  • 59 Hilbert G, Gruson D, Vargas F et al.. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.  N Engl J Med. 2001;  344 (7) 481-487
  • 60 Lightowler J V, Wedzicha J A, Elliott M W, Ram F S. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis.  BMJ. 2003;  326 (7382) 185
  • 61 Masip J, Roque M, Sánchez B, Fernández R, Subirana M, Expósito J A. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis.  JAMA. 2005;  294 (24) 3124-3130
  • 62 Ferrer M, Esquinas A, Leon M, Gonzalez G, Alarcon A, Torres A. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial.  Am J Respir Crit Care Med. 2003;  168 (12) 1438-1444
  • 63 Agarwal R, Reddy C, Aggarwal A N, Gupta D. Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis.  Respir Med. 2006;  100 (12) 2235-2238
  • 64 Hui D S, Ip M, Tang J W et al.. Airflows around oxygen masks: a potential source of infection?.  Chest. 2006;  130 (3) 822-826
  • 65 Miller III R R, Markewitz B A, Rolfs R T et al.. Clinical findings and demographic factors associated with ICU admission in Utah due to novel 2009 influenza A(H1N1) infection.  Chest. 2010;  137 (4) 752-758
  • 66 Ramsey C D, Funk D, Miller III R R, Kumar A. Ventilator management for hypoxemic respiratory failure attributable to H1N1 novel swine origin influenza virus.  Crit Care Med. 2010;  38 (4, Suppl) e58-e65
  • 67 Kolobow T, Moretti M P, Fumagalli R et al.. Severe impairment in lung function induced by high peak airway pressure during mechanical ventilation: an experimental study.  Am Rev Respir Dis. 1987;  135 (2) 312-315
  • 68 Brower R G, Lanken P N, MacIntyre N National Heart, Lung, and Blood Institute ARDS Clinical Trials Network et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome.  N Engl J Med. 2004;  351 (4) 327-336
  • 69 Bulger E M, Jurkovich G J, Gentilello L M, Maier R V. Current clinical options for the treatment and management of acute respiratory distress syndrome.  J Trauma. 2000;  48 (3) 562-572
  • 70 Amato M B, Barbas C S, Medeiros D M et al.. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome.  N Engl J Med. 1998;  338 (6) 347-354
  • 71 Meade M O, Cook D J, Guyatt G H Lung Open Ventilation Study Investigators et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.  JAMA. 2008;  299 (6) 637-645
  • 72 Mercat A, Richard J C, Vielle B Expiratory Pressure (Express) Study Group et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial.  JAMA. 2008;  299 (6) 646-655
  • 73 The HIFI Study Group . High-frequency oscillatory ventilation compared with conventional mechanical ventilation in the treatment of respiratory failure in preterm infants.  N Engl J Med. 1989;  320 (2) 88-93
  • 74 Piedalue F, Albert R K. Prone positioning in acute respiratory distress syndrome.  Respir Care Clin N Am. 2003;  9 (4) 495-509
  • 75 Gattinoni L, Tognoni G, Pesenti A Prone-Supine Study Group et al. Effect of prone positioning on the survival of patients with acute respiratory failure.  N Engl J Med. 2001;  345 (8) 568-573
  • 76 Guerin C, Gaillard S, Lemasson S et al.. Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial.  JAMA. 2004;  292 (19) 2379-2387
  • 77 Davies A, Jones D, Bailey M Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome.  JAMA. 2009;  302 (17) 1888-1895
  • 78 Napolitano L M, Park P K, Raghavendran K, Bartlett R H. Nonventilatory strategies for patients with life-threatening 2009 H1N1 influenza and severe respiratory failure.  Crit Care Med. 2010;  38 (4, Suppl) e74-e90
  • 79 Peek G J, Moore H M, Moore N, Sosnowski A W, Firmin R K. Extracorporeal membrane oxygenation for adult respiratory failure.  Chest. 1997;  112 (3) 759-764
  • 80 Hemmila M R, Rowe S A, Boules T N et al.. Extracorporeal life support for severe acute respiratory distress syndrome in adults.  Ann Surg. 2004;  240 (4) 595-605 discussion 605-607
  • 81 Peek G J, Mugford M, Tiruvoipati R CESAR trial collaboration et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.  Lancet. 2009;  374 (9698) 1351-1363
  • 82 Santos C D, Bristow R B, Vorenkamp J V. Which health care workers were most affected during the spring 2009 H1N1 pandemic?.  Disaster Med Public Health Prep. 2010;  4 (1) 47-54
  • 83 Poalillo F E, Geiling J, Jimenez E J. Healthcare personnel and nosocomial transmission of pandemic 2009 influenza.  Crit Care Med. 2010;  38 (4, Suppl) e98-e102
  • 84 Centers for Disease Control and Prevention (CDC) . Novel influenza A (H1N1) virus infections among health-care personnel—United States, April–May 2009.  MMWR Morb Mortal Wkly Rep. 2009;  58 (23) 641-645
  • 85 Loeb M B. Severe acute respiratory syndrome: preparedness, management, and impact.  Infect Control Hosp Epidemiol. 2004;  25 (12) 1017-1019
  • 86 Oberg T, Brosseau L M. Surgical mask filter and fit performance.  Am J Infect Control. 2008;  36 (4) 276-282
  • 87 Talbot T R, Crocker D D, Peters J et al.. Duration of virus shedding after trivalent intranasal live attenuated influenza vaccination in adults.  Infect Control Hosp Epidemiol. 2005;  26 (5) 494-500
  • 88 Wilde J A, McMillan J A, Serwint J, Butta J, O'Riordan M A, Steinhoff M C. Effectiveness of influenza vaccine in health care professionals: a randomized trial.  JAMA. 1999;  281 (10) 908-913
  • 89 Pandemic Influenza Resources. http://www.cdc.gov/flu/tools/flusurge.htm
  • 90 Nap R E, Andriessen M P, Meessen N E, van der Werf T S. Pandemic influenza and hospital resources.  Emerg Infect Dis. 2007;  13 (11) 1714-1719
  • 91 Hota S, Fried E, Burry L, Stewart T E, Christian M D. Preparing your intensive care unit for the second wave of H1N1 and future surges.  Crit Care Med. 2010;  38 (4, Suppl) e110-e119
  • 92 Hick J L, Hanfling D, Burstein J L et al.. Health care facility and community strategies for patient care surge capacity.  Ann Emerg Med. 2004;  44 (3) 253-261
  • 93 Hick J L, Barbera J A, Kelen G D. Refining surge capacity: conventional, contingency, and crisis capacity.  Disaster Med Public Health Prep. 2009;  3 (2, Suppl) S59-S67
  • 94 Hanley M E, Bogdan G M. Mechanical ventilation in mass casualty scenarios. Augmenting staff: project XTREME.  Respir Care. 2008;  53 (2) 176-188 discussion 189
  • 95 Rubinson L, Hick J L, Curtis J R Task Force for Mass Critical Care et al. Definitive care for the critically ill during a disaster: medical resources for surge capacity: from a Task Force for Mass Critical Care summit meeting, January 26–27, 2007, Chicago, IL.  Chest. 2008;  133 (5, Suppl) 32S-50S

Glen P WestallM.B.B.S. Ph.D. 

Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital

Commercial Rd., Melbourne, Vic 3181, Australia

Email: G.Westall@alfred.org.au

    >