key: cord-0000397-unotv53r
authors: Ñamendys-Silva, Silvio A; Hernández-Garay, Marisol; Rivero-Sigarroa, Eduardo
title: Non-invasive ventilation for critically ill patients with pandemic H1N1 2009 influenza A virus infection
date: 2010-03-17
journal: Crit Care
DOI: 10.1186/cc8883
sha: 1fb70b7765063ceabb21446f1ec671e849b7b7be
doc_id: 397
cord_uid: unotv53r

nan

We read with interest the study reported by Rello and colleagues [1] . Th e authors described the fi rst 32 documented patients with pandemic infl uenza A H1N1 (PIAH1N1) virus infection hospitalized in an intensive care unit (ICU) in Spain. Twenty-four patients (75.0%) had refractory hypo xemia and required advanced mechanical ventilation. Eight patients (33.3%) received noninvasive mechanical ventilation at ICU admission. Six of these patients (75%) required further orotracheal intubation and invasive mechanical ventilation and two (33%) died.

Non-invasive ventilation (NIV) is not recommended for patients with PIAH1N1 virus infection complicated by pneumonia, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) because although NIV temporarily improves oxygenation and reduces the work of breathing in these patients, it does not necessarily change the natural disease course. On the other hand, NIV may increase the risk of respiratory pathogen transmission [2] and there is not enough evidence to support the treatment of ALI/ARDS with NIV. To date, three studies have suggested that NIV has not been successful in critically ill patients with hypoxemic respiratory failure attributable to PIAH1N1 virus infection [1, 3, 4] . In these studies a total of 76 patients received NIV, but 64 (84.2%) of these patients required subsequent intubation and invasive ventilation.

Considering the high failure rate of NIV therapy in patients with PIAH1N1 virus infection and ALI/ARDS, the treatment of ARDS associated with the PIAH1N1 virus infection should be based upon published, evidence-based guidelines for sepsis-associated ARDS. Standard lung-protective ventilation strategies are appropriate initially [2, 5] . We appreciate the interest of Dr Ñamendys-Silva and colleagues in our article [1] and their insightful observations regarding ventilator management of severe PIAH1N1 virus infection. We agree that NIV is not recommended for patients with respiratory failure due to PIAH1N1 virus infection. However, several points should be clarifi ed. Use of NIV in ARDS remains controversial and the etiology of hypoxemia seems to be an important determinant of successful outcome. Our results describe our national clinical practice in the current pandemic and it is consistent with other reports [3, 6] . Other authors have recently reported that, in centers with expertise on NIV, 30% of patients with ARDS were treated with NIV as a fi rst-line intervention and 30 to 50% of these avoided orotracheal intubation [1, 3, 6] . Th us, only a small number of patients with ARDS benefi ted from NIV in expert centers, always needing close monitoring in the ICU setting. In selected patients with milder presentation a conservative ventilator approach should be considered until additional data from 2009 PIAH1N1 is obtained.

Abbreviations ALI, acute lung injury; ARDS, acute respiratory distress syndrome; ICU, intensive care unit; NIV, non-invasive ventilation; PIAH1N1, pandemic infl uenza A H1N1. 

León-Gil C; the H1N1 SEMICYUC Working Group: Intensive care adults patients with severe respiratory failure caused by infl uenza A (H1N1)v in Spain

Clinical management of pandemic (H1N1) infection

for the Canadian Critical Care Trials Group H1N1 Collaborative: Critically ill patients with 2009 infl uenza A (H1N1) infection in Canada

Clinical fi ndings and demographic factors associated with intensive care unit admission in Utah due to 2009 novel infl uenza A (H1N1) infection

World Health Organization: Clinical management of human infection with pandemic (H1N1) 2009: revised guidance

A multiple-center survey on the use in clinical practice of onoinvasive ventilation as a fi rstline intervention for caute respiratory distress síndrome

Non-invasive ventilation for critically ill patients with pandemic H1N1 2009 infl uenza A virus infection

The authors declare that they have no competing interests.Published: 17 March 2010