• G Grasselli, M Bombino, N Patroniti, G Foti, A Benini, C Abbruzzese, R Fumagalli, and A Pesenti.
• Department of Perioperative Medicine and Intensive Care, San Gerardo Hospital, Monza, Italy. jaku71@gmail.com
• Minerva Anestesiol. 2011 Sep 1;77(9):884-91.

BackgroundThe novel influenza A (H1N1) pandemic was associated with an epidemic of critical illness.MethodsWe 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.ResultsFrom 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.ConclusionIn 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.

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