Follow-up after acute respiratory distress syndrome caused by influenza a (H1N1) virus infection

BACKGROUND: There are no reports on the long-term follow-up of patients with swine-origin influenza A virus infection that progressed to acute respiratory distress syndrome. METHODS: Four patients were prospectively followed up with pulmonary function tests and high-resolution computed tomography for six months after admission to an intensive care unit. RESULTS: Pulmonary function test results assessed two months after admission to the intensive care unit showed reduced forced vital capacity in all patients and low diffusion capacity for carbon monoxide in two patients. At six months, pulmonary function test results were available for three patients. Two patients continued to have a restrictive pattern, and none of the patients presented with abnormal diffusion capacity for carbon monoxide. All of them had a diffuse ground-glass pattern on high-resolution computed tomography that improved after six months. CONCLUSIONS: Despite the marked severity of lung disease at admission, patients with acute respiratory distress syndrome caused by swine-origin influenza A virus infection presented a late but substantial recovery over six months of follow-up.

Ventilação mecânica não invasiva em pacientes com síndrome respiratória aguda grave, suspeitos de infecção por influenza A - H1N1: relato de casos / Non invasive mechanical ventilation in acute lung injury and swine-origin influenza A H1N1 suspicion: case report

Objetivo: Apresentar, através de relato de caso, a aplicação da ventilação mecânica não invasiva (VMNI) em pacientes com Síndrome Respiratória Aguda Grave (SRAG), suspeitos de H1N1, internados no Centro de Terapia Intensiva (CTI) do Hospital Eduardo de Menezes (HEM). Materiais e Métodos: Quatro mulheres com idades entre 16 e 50 anos, com SRAG, foram submetidas à VMNI em ventiladores micro processados utilizando a máscara full face, com parâmetros mínimos a fim de melhorar a taquidispnéia e a queda da saturação de oxigênio, conforme protocolo criado pela equipe do CTI do HEM. Resultado: após aplicação da VMNI houve melhora do padrão respiratório e da saturação, observados clinicamente e através de gasometria e RX, menor permanência no CTI (3-5 dias), e não houve necessidade de intubação orotraqueal, diminuindo complicações e custos da mesma. Conclusão: Embora a VMNI tenha sido evidenciada como uma pratica controversa para os pacientes sob investigação de H1N1, neste relato de caso mostrou-se eficaz quando aplicado criteriosamente e bem indicado.(AU)

Objectives: To present, in a series of case reports, the use of non invasive ventilation (NIV) in patients with acute lung injury (ALI) and swine-origin influenza A H1N1 suspicion, in Intensive Care Unit of Eduardo de Menezes Hospital (HEM). Materials and Methods: Four women, aged between 16 and 50, with ALI, underwent a protocol of NIV in micro processed ventilators, using full face mask and minimal parameters to obtain an improvement of tachidispnoea and drop of oxygen saturation; according to protocol created by UCI team. Results: There was an improvement of respiratory pattern and saturation, seen clinically and through arterial blood gas analyses and chest radiography; shorter stay in UCI (3-5 days), and there was no need of endotracheal intubation, decreasing complications and costs. Conclusion: Although NIV has been a controversial practice to patients under suspicion of swine-origin influenza, this case report showed efficacy when carefully applied and indicated.(AU)