Ventilatory and ECMO treatment of H1N1-induced severe XXXX : results of an Italian referral ECMO center.

@entity1 @entity548 @entity649 @entity281 @entity683 @entity2114 @entity1576 @entity325
BACKGROUND: Since the first outbreak of a @entity1576 caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy @entity1 . Here we describe our experience in H1N1-induced @entity649 using both ventilation strategy and ECMO assistance. METHODS: Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic @entity683 . From Sept 09 to Jan 10, all @entity1 admitted to our Intensive Care Unit (ICU) of the Emergency Department with @entity649 due to @entity281 were studied. All ECMO treatments were veno-venous. @entity281 was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination. RESULTS: A total of 12 @entity1 were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two @entity1 had @entity325 by @entity2114 . One @entity1 was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing @entity1 safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, @entity548 from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. CONCLUSIONS: In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced @entity649 . Lung ultrasound is an effective mean for daily assessment of @entity649 @entity1 .
