Giuseppe
Emeritus
Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection (CHEST, abstract, edited)
[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/137/4/916.short?rss=1">Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection ? CHEST</cite>. Abstract, edited.]
Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection
1. David S. Hui, MD, FCCP, 2. Nelson Lee, MD and 3. Paul K. S. Chan, MD
Author Affiliations
1. From the Department of Medicine and Therapeutics (Drs Hui and Lee), the Stanley Ho Center for Emerging Infectious Diseases, School of Public Health & Primary Care (Drs Hui, Lee, and Chan), and the Department of Microbiology (Dr Chan), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
1. Correspondence to: David S Hui, MD, FCCP, Division of Respiratory Medicine, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong; e-mail: dschui@cuhk.edu.hk
Abstract
Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
* Abbreviations: ECMO extracorporeal membrane oxygenation, HCW health-care worker, IMV invasive mechanical ventilation, MRSA methicillin-resistant Staphylococcus aureus, NAC N-acetyl-L-cysteine, NPPV noninvasive positive pressure ventilation, pandemic A(H1N1) pandemic 2009 influenza A(H1N1), ROS reactive oxygen species, RT-PCR reverse transcription-polymerase chain reaction, SARS severe acute respiratory syndrome, WHO World Health Organization
* Received October 3, 2009. Accepted December 12, 2009.
* ? 2010 American College of Chest Physicians
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[Source: Chest, full text: <cite cite="http://chestjournal.chestpubs.org/content/137/4/916.short?rss=1">Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection ? CHEST</cite>. Abstract, edited.]
Clinical Management of Pandemic 2009 Influenza A(H1N1) Infection
1. David S. Hui, MD, FCCP, 2. Nelson Lee, MD and 3. Paul K. S. Chan, MD
Author Affiliations
1. From the Department of Medicine and Therapeutics (Drs Hui and Lee), the Stanley Ho Center for Emerging Infectious Diseases, School of Public Health & Primary Care (Drs Hui, Lee, and Chan), and the Department of Microbiology (Dr Chan), The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
1. Correspondence to: David S Hui, MD, FCCP, Division of Respiratory Medicine, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong; e-mail: dschui@cuhk.edu.hk
Abstract
Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).
* Abbreviations: ECMO extracorporeal membrane oxygenation, HCW health-care worker, IMV invasive mechanical ventilation, MRSA methicillin-resistant Staphylococcus aureus, NAC N-acetyl-L-cysteine, NPPV noninvasive positive pressure ventilation, pandemic A(H1N1) pandemic 2009 influenza A(H1N1), ROS reactive oxygen species, RT-PCR reverse transcription-polymerase chain reaction, SARS severe acute respiratory syndrome, WHO World Health Organization
* Received October 3, 2009. Accepted December 12, 2009.
* ? 2010 American College of Chest Physicians
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