Scientific Tracks Abstracts: JAA
The worldwide 2009-2010 pandemic of novel H1N1 infl uenza reminds us that infl uenza can still be a lethal disease. Severe respiratory failure (including acute lung injury and acute respiratory distress syndrome) caused by 2009 H1N1 infl uenza infection has been reported worldwide. Refractory hypoxemia is a common fi nding in these patients and can be challenging to manage. Refractory hypoxemia in H1N1 ARDS is associated with high mortality (15-40%). Th is usually requires high ventilator settings with nonconventional modes of ventilation, and extracorporeal membrane oxygenation in some cases (5-10%). Use of HFOV has shown a non-signifi cant trend towards improved oxygenation in severe ARDS when conventional ventilation failed. Th is is probably the fi rst report of successful use of HFOV in H1N1 ARDS. Early initiation of antiviral and antibiotic therapy along with proper supportive therapy helped in better outcome. We present a case of ARDS secondary to infection with the infl uenza A (H1N1) virus. ?A 36 year old male patient was brought to casualty with h/o fever and breathlessness. Patient was admitted to ICU in severe sepsis with ARDS. Patient had high leukocyte count (13,000-16,000/cu.mm), low platelet count (75000/-), deranged liver and kidney functions. Bacterial cultures of blood, urine and broncho-alveolar lavage (BAL) were negative. Peripheral smear of blood for Malaria parasite and dengue serology were negative. However H1N1 antigen was positive. Tablet Oseltamivir 75 mg twice daily was started along with intravenous antibiotic therapy. He was put on mechanical ventilation and Infusion dopamine to support hemodynamic. He continued to remained febrile, required high FiO2 (0.7-0.8) and PEEP (15 cm H2O) to maintain oxygenation (PaO2 60-70). On fi ft h day of his admission to ICU, based on the above fi ndings, high frequency oscillatory ventilation (HFOV) was started with FiO2 0.7, frequency 5.0, amplitude 86 and mean airway pressure 25. Aft er two hours PaO2 increase to 120 and steadily improved further. Over next 48 hours, FiO2 could be decreased below 0.5, dopamine was stopped and liver and kidney function started showing improving trends. HFOV was continued for three days and thereaft er he was weaned off to minimal SIMV support. He was subsequently discharged from ICU to step down unit on day fi ft een of his admission.?
Dr. Chandralekha completed her MBBS in 1972 and M.D Anesthesiology in 1975 from King George?s Medical College, Lucknow. She is Professor & Head, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi-110029, a premier medical college of the country. She has published many articles in reputed generals and has been invited as a speaker and to share her clinical experience with experts of other countries. Her fi eld of specialization is anesthesia for renal transplantation and intensive care. She is board member of Indian College of Anesthesiology and Chairperson of academic committee of ICA. She is also a executive member of Bureau of Indian standard (BIS), chairperson of standardizing anesthesia & resuscitation equipment & member of ISO.