[Favorable outcome of acute respiratory failure caused by H1N1 virus infection in critical patients]. / Evolución favorable de insuficiencia respiratoria aguda por gripe A (H1N1) en pacientes críticos.

OBJECTIVE: To describe clinical features, treatment, complications, and outcomes in cases of acute respiratory distress syndrome (ARDS) caused by H1N1 virus infection treated in an anesthesia department's recovery unit. MATERIALS AND METHODS: Patients were those admitted to our recovery unit with H1N1 virus infection confirmed by reverse transcription polymerase chain reaction, nasopharyngeal swabs, and/or bronchial aspirates. RESULTS: From August to December 2009, we admitted 8 patients (mean age, 43 [range 24-46] years) to the recovery unit. Six were men, three were of Roma origin, and 50% had concomitant diseases. Mean (SD) time from symptom onset to admittance to the recovery unit was 3.25 (1.6) days. Four had received broad-spectrum antibiotics during the last month. Six had primary viral pneumonia, 1 had secondary bacterial pneumonia and 1 had exacerbated chronic obstructive pulmonary disease. Three had bacterial coinfection, and 4 developed multiple organ dysfunction syndrome and ARDS, requiring mechanical ventilation (5.75 [3.10] days) and vasopressors (4.25 [3.40] days). The mean ratio of PaO2 to the inspired oxygen fraction at admittance was 93.8 (31.0) and the mean positive end-expiratory pressure applied was 14.5 (4.2) cm H2O. Oseltamivir was administered (150 mg/12 h) with a mean delay of 3.88 (1.64) days. Additional inhaled zanamivir was administered on day 7 to a patient with a positive viral culture. Antibiotics were prescribed following the guidelines of the American Thoracic Society and Infectious Diseases Society of America for community-acquired pneumonia (50% of the cases) and healthcare-associated pneumonia (50%). Seven subjects received 1 mg x kg(-1) x day(-1) of methylprednisolone. Patients with mechanical ventilation required continuous insulin infusion (maximum daily dosage, 87 [50.3] IU) to maintain blood glucose levels between 80 and 150 mg x dL(-1). Patients under mechanical ventilation achieved a negative net fluid balance. All patients survived and were discharged from the recovery unit in 7.38 (4.83) days (range, 2-16 days) and subsequently discharged home in 13.25 (7.74) days (range, 6-27 days). All were alive 60 days after discharge. CONCLUSION: In this series of critically ill patients with H1N1 virus infection that was initially life-threatening, all responded favorably to conventional treatment and could be discharged.

Effects of isoflurane on intraventricular pressure in neurosurgical patients.

The effect of isoflurane on intraventricular pressure (IVP) was examined during nitrous oxide with fentanyl anaesthesia in patients undergoing craniotomy during normocapnia or hypocapnia. Hypocapnic patients (n = 30, PaCO2 3.3 (0.1) kPa) were allocated to three groups (A, B, C; n = 10 each) according to the inspired concentration of isoflurane (1%, 1.5%, 2%). Normocapnic patients (n = 10, PaCO2 4.7 (0.1) kPa) received an inspired concentration of 1% isoflurane (group D). In patients in groups C and D, IVP increased significantly in response to isoflurane (P less than 0.01). In groups A and B, IVP did not change significantly (P greater than 0.05). Mean arterial pressure and cerebral perfusion pressure decreased significantly (P less than 0.001) in all groups in response to isoflurane.