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Prepare now for H1N1, intensive-care units told
Patients critically ill with virus difficult to treat
By: Helen Branswell
1/09/2009
Dr. Anand Kumar, in an intensive-care ward at St. Boniface General Hospital, says H1N1 patients require very high doses of sedation.
TORONTO -- Intensive-care specialists who fought to save desperately sick H1N1 flu patients this spring and summer have a warning for hospitals that haven't yet dealt with an influx of these difficult-to-treat patients.
Prepare. Now.
Experts predict ICUs are likely to be the main battlefield in the war against the pandemic virus, which so far doesn't appear to have much of a middle ground.
The vast majority of people suffer through a typical bout of flu. But of those who become sick enough to be hospitalized, a significant portion -- maybe as high as 15 per cent, the World Health Organization says -- end up in ICUs for weeks, hovering between life and death.
"I've never seen this," says Dr. Paul Hebert, editor of the Canadian Medical Association Journal and an intensive-care physician in Ottawa who has treated several of these patients.
"As an ICU doctor, it's very, very, very rare I can't deliver enough oxygen to someone to keep him alive. They die of other things, right? They die because their organs fail. In this case, we can barely oxygenate them."
The worst-hit hospitals talk of having been on the brink of not being able to cope. They describe nearly running out of specialized equipment and the skilled staff needed to monitor these highly unstable patients in their high-tech hospital beds.
Public health officials need to look for ways to keep novel H1N1 patients from getting this sick and help hospitals access enough key drugs, equipment and even staff to cope with an expected surge of cases in the fall and winter, says Dr. Anand Kumar, an intensive-care physician who has treated dozens of these patients in Winnipeg.
Kumar was so concerned about what he saw in the city's ICUs earlier this year that he has been agitating, in medical and political circles, for stepped-up pandemic preparations for the country's hospitals.
"I want the public-health people to understand: If we breach ICU capacity, a lot of people are going to die," he cautions.
"What I've been telling everybody is: 'You've got to think about the ICU, because the ICU, for these kinds of events, is your choke point."'
Kumar's warnings appear to have been heard. The Public Health Agency of Canada has convened a meeting this Wednesday and Thursday in Winnipeg designed to bring together critical-care and public-health experts to brainstorm on how to prepare for the next wave of illness.
The scientific director of the agency's National Microbiology Laboratory says one of the goals of the meeting is to try to figure out what leads to severe disease, in the hopes some such cases can be averted. But it's also about alerting intensive-care specialists who haven't yet dealt with these types of cases about what to expect, what works, what doesn't and what problems might arise.
"My understanding, from talking to the ICU docs across the country, but mainly in Winnipeg, is that there are some particular challenges with managing the people who have severe pneumonitis (inflammation of the lungs)," says Dr. Frank Plummer. "Understanding that and exchanging that information between intensive-care doctors is important."
Kumar notes these patients require high doses of sedating medications for long periods of time, so they don't struggle and actually fight against the ventilators being used to keep them alive.
During Winnipeg's outbreak, the hospitals treating severely ill H1N1 patients went through a year's supply of the sedating drugs in just two months, Kumar says.
"For some reason -- and we don't know why yet -- these patients are incredibly agitated and require incredibly high doses of sedation," he says, adding he's asked federal officials to alert manufacturers so they can step up production.
Winnipeg treated about 50 confirmed H1N1 cases and another 15 who looked just like them but didn't test positive for the virus.
Kumar thinks the recommended test -- a swab inserted deep into the nose -- isn't reliable in severely ill patients. He thinks other specimens, from lower down in the respiratory tract, should be searched for viruses.
He's warned his ICU peers that patients who look like H1N1 cases probably are H1N1 cases and should be treated as such.
-- The Canadian Press
http://www.winnipegfreepress.com/br...-h1n1-intensive-care-units-told-56534792.html
Patients critically ill with virus difficult to treat
By: Helen Branswell
1/09/2009
Dr. Anand Kumar, in an intensive-care ward at St. Boniface General Hospital, says H1N1 patients require very high doses of sedation.
TORONTO -- Intensive-care specialists who fought to save desperately sick H1N1 flu patients this spring and summer have a warning for hospitals that haven't yet dealt with an influx of these difficult-to-treat patients.
Prepare. Now.
Experts predict ICUs are likely to be the main battlefield in the war against the pandemic virus, which so far doesn't appear to have much of a middle ground.
The vast majority of people suffer through a typical bout of flu. But of those who become sick enough to be hospitalized, a significant portion -- maybe as high as 15 per cent, the World Health Organization says -- end up in ICUs for weeks, hovering between life and death.
"I've never seen this," says Dr. Paul Hebert, editor of the Canadian Medical Association Journal and an intensive-care physician in Ottawa who has treated several of these patients.
"As an ICU doctor, it's very, very, very rare I can't deliver enough oxygen to someone to keep him alive. They die of other things, right? They die because their organs fail. In this case, we can barely oxygenate them."
The worst-hit hospitals talk of having been on the brink of not being able to cope. They describe nearly running out of specialized equipment and the skilled staff needed to monitor these highly unstable patients in their high-tech hospital beds.
Public health officials need to look for ways to keep novel H1N1 patients from getting this sick and help hospitals access enough key drugs, equipment and even staff to cope with an expected surge of cases in the fall and winter, says Dr. Anand Kumar, an intensive-care physician who has treated dozens of these patients in Winnipeg.
Kumar was so concerned about what he saw in the city's ICUs earlier this year that he has been agitating, in medical and political circles, for stepped-up pandemic preparations for the country's hospitals.
"I want the public-health people to understand: If we breach ICU capacity, a lot of people are going to die," he cautions.
"What I've been telling everybody is: 'You've got to think about the ICU, because the ICU, for these kinds of events, is your choke point."'
Kumar's warnings appear to have been heard. The Public Health Agency of Canada has convened a meeting this Wednesday and Thursday in Winnipeg designed to bring together critical-care and public-health experts to brainstorm on how to prepare for the next wave of illness.
The scientific director of the agency's National Microbiology Laboratory says one of the goals of the meeting is to try to figure out what leads to severe disease, in the hopes some such cases can be averted. But it's also about alerting intensive-care specialists who haven't yet dealt with these types of cases about what to expect, what works, what doesn't and what problems might arise.
"My understanding, from talking to the ICU docs across the country, but mainly in Winnipeg, is that there are some particular challenges with managing the people who have severe pneumonitis (inflammation of the lungs)," says Dr. Frank Plummer. "Understanding that and exchanging that information between intensive-care doctors is important."
Kumar notes these patients require high doses of sedating medications for long periods of time, so they don't struggle and actually fight against the ventilators being used to keep them alive.
During Winnipeg's outbreak, the hospitals treating severely ill H1N1 patients went through a year's supply of the sedating drugs in just two months, Kumar says.
"For some reason -- and we don't know why yet -- these patients are incredibly agitated and require incredibly high doses of sedation," he says, adding he's asked federal officials to alert manufacturers so they can step up production.
Winnipeg treated about 50 confirmed H1N1 cases and another 15 who looked just like them but didn't test positive for the virus.
Kumar thinks the recommended test -- a swab inserted deep into the nose -- isn't reliable in severely ill patients. He thinks other specimens, from lower down in the respiratory tract, should be searched for viruses.
He's warned his ICU peers that patients who look like H1N1 cases probably are H1N1 cases and should be treated as such.
-- The Canadian Press
http://www.winnipegfreepress.com/br...-h1n1-intensive-care-units-told-56534792.html