• Marco Confalonieri, Rossella Cifaldi, Lorella Dreas, Marino Viviani, Marco Biolo, and Marco Gabrielli.
• Pneumology Department, University Hospital of Cattinara, Str. Di Fiume 447, 34149 Trieste, Italy. marco.confalonieri@aots.sanita.fvg.it
• Ther Adv Respir Dis. 2010 Aug 1;4(4):233-7.

BackgroundDuring winter 2009 we treated with prolonged corticosteroid infusion eight consecutive patients affected by H1N1-virus infection and severe pneumonia. The most severe patient was a previously healthy 30-year-old man admitted to hospital because of bilateral pneumonia and severe acute respiratory failure.MethodH1N1-virus infection was detected by broncho-alveolar lavage performed on day 1. After some days following admission the patient was still in a life-threatening state, not responding to oseltamivir, protective mechanical ventilation and veno-arterial extracorporeal membrane oxygenation (ECMO).ResultsThe addition of methylprednisolone infusion at a stress dose (1 mg/kg/24 h) as rescue therapy significantly and rapidly improved the clinical condition. Weaning from ECMO and invasive mechanical ventilation was possible within a relatively few days.ConclusionAccording to the literature reports more than 34% of H1N1-virus severe infections were treated with corticosteroids. This report and our experience may suggest a possible life-saving use of corticosteroids at a stress dose in severely ill patients with an H1N1-virus infection that is not responding to the most advanced treatments.

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