Acute respiratory distress syndrome (ARDS) complicating influenza A/H1N1 infection - a clinical approach
More details
Hide details
Department of Internal Diseases, Medical University, Lublin, Poland
II Department of Radiology, Medical University, Lublin, Poland
II Department of Anaesthesiology and Intensive Care, Medical University, Lublin, Poland
Military Institute of Hygiene and Epidemiology, Biological Threat Identification and Countermeasures Centre, Pulawy, Poland
Department of Dermatology, Venerology and Pediatric Dermatology, Medical University, Lublin, Poland
Department of Infectious Diseases, Medical University, Lublin, Poland
Ann Agric Environ Med. 2013;20(4):820–822
ARDS is defined as an acute inflammatory syndrome characterized with bilateral parenchymal lung infiltrates on chest radiograph and PaO2/FiO2 ratio<200 resulting from causes other than acute left ventricular dysfunction. Inflammatory lung lesions may be induced by different disorders, with sepsis being the leading cause of ARDS. Other causes include infectious pneumonia, aspiration of gastric contents, drugs, severe trauma, fat embolism, surface burn, massive blood transfusion. Influenza A/H1N1 infection seems to be responsible for the development of extremely severe type of ARDS with poor response to routine treatment. Despite great progress in the management of ARDS with novel agents and sophisticated techniques, including antimicrobial drugs, extracorporeal membrane oxygenation, prostaglandins, nitric oxide, prostacyclin, exogenous surfactant administration and activated protein C, supportive treatment based mostly on advanced mechanical ventilation in the intensive care units seems to be the most important for the prognosis.
Andrzej Prystupa   
Department of Internal Diseases, Medical University, Lublin, Poland
1. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009; 361(20): 1935–44.
2. Jaber S, Conseil M, Coisel Y, Jung B, Chanques G. ARDS and influenza A (H1N1): patients’ characteristics and management in intensive care unit. Ann Fr Anesth Reanim. 2010; 29(2): 117–25.
3. British Infection Society, British Thoracic Society, Health Protection Agency. Pandemic flu: clinical management of patients with an influenza-like illness during an influenza pandemic. Provisional guidelines from the British Infection Society, British Thoracic Society and Health Protection Agency in collaboration with the Department of Health. Thorax 2007; 62 (Suppl 1): 1–46.
4. Jain R, Dalnogare A. Pharmacological Therapy for Acute Respiratory Distress Syndrome Mayo Clin Proc. 2006; 81(2): 205–212.
5. Zambon M, Vincent JL. Mortality rates for patients with acute lung injury/ARDS have decreased over time. Chest. 2008; 133(5): 1120–7.
6. Henzler T, Meyer M, Kalenka A, Alb M, Schmid-Bindert G, Bartling S, et al. Image Findings of Patients with H1N1 Virus Pneumonia and Acute Respiratory Failure. Acad Radiol. 2010; 17(6): 681–685.
7. Busi Rizzi E, SchininĂ V, Ferraro F, Rovighi L, Cristoforo M, Chiapetta D, et al. Radiological findings of pneumonia in patients with swine-origin influenza A virus (H1N1). Radiol Med. 2010; 115: 507–515.
8. Urso R, Bevilacqua N, Gentile M, Biagioli D, Lauria FN. Pandemic 2009 H1N1 virus infection associated with purpuric skin lesions: a case report. J Med Case Reports. 2011; 5(1): 132.
9. Ferguson ND, Frutos-Vivar F, Esteban A, Anzueto A, Alia I, Brower RG, et al. Mechanical Ventilation International Study Group. Airway pressures, tidal volumes, and mortality in patients with acute respiratory distress syndrome. Crit Care Med. 2005; 33: 21–30.
10. Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA 2009; 302: 1888–1895.