• Andrew R Lai, Kevin Keet, Celina M Yong, and Janet V Diaz.
• University of California, San Francisco, 94143-0131, USA. alai@medicine.ucsf.edu
• Am. J. Med. 2010 Mar 1;123(3):282-285.e2.

BackgroundAcute respiratory distress syndrome resulting from novel influenza A virus (H1N1) infection remains uncommon.MethodsWe describe the clinical profiles of adult patients with acute respiratory distress syndrome due to microbiologically confirmed H1N1 admitted to a medical intensive care unit in San Francisco, California over a 2-month period.ResultsBetween June 1 and July 31, 2009, 7 patients (age range: 25-66 years; 4 patients under the age of 40 years; 6 male; 1 pregnant) were diagnosed with H1N1, with 5 of 6 (83%) having initial false-negative rapid testing. All developed respiratory failure complicated by acute respiratory distress syndrome, with 4 additionally developing multiorgan dysfunction. All were managed with a lung protective ventilator strategy (average number of days on the ventilator: 16), and 4 patients also required additional rescue therapies for refractory hypoxemia, including very high positive end-expiratory pressure, inhaled epoprostenol, recruitment maneuvers, and prone positioning. Despite these measures, 3 patients (43%) ultimately died.ConclusionsClinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy.2010 Elsevier Inc. All rights reserved.

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