Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure

Results of an Italian referral ECMO center

Giovanni Cianchi, Manuela Bonizzoli, Andrea Pasquini, Massimo Bonacchi, Giovanni Zagli, Marco Ciapetti, Guido Sani, Stefano Batacchi, Simona Biondi, Pasquale Bernardo, Chiara Lazzeri, Valtere Giovannini, Alberta Azzi, Rosanna Abbate, Gianfranco Gensini, Adriano Peris

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Background: Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.Methods: Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.Results: A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%.Conclusions: In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.

Original languageEnglish
Article number2
JournalBMC Pulmonary Medicine
Volume11
DOIs
Publication statusPublished - Jan 11 2011

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Extracorporeal Membrane Oxygenation
Respiratory Insufficiency
Referral and Consultation
Lung
Bronchoalveolar Lavage
Therapeutics
Legionella pneumophila
H1N1 Subtype Influenza A Virus
Polymerase Chain Reaction
Emergency Medical Services
Pandemics
Mechanical Ventilators
Critical Care
Patient Safety
Mexico
Infection
Coinfection
Artificial Respiration
Radiology
Teaching Hospitals

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure : Results of an Italian referral ECMO center. / Cianchi, Giovanni; Bonizzoli, Manuela; Pasquini, Andrea; Bonacchi, Massimo; Zagli, Giovanni; Ciapetti, Marco; Sani, Guido; Batacchi, Stefano; Biondi, Simona; Bernardo, Pasquale; Lazzeri, Chiara; Giovannini, Valtere; Azzi, Alberta; Abbate, Rosanna; Gensini, Gianfranco; Peris, Adriano.

In: BMC Pulmonary Medicine, Vol. 11, 2, 11.01.2011.

Research output: Contribution to journalArticle

Cianchi, G, Bonizzoli, M, Pasquini, A, Bonacchi, M, Zagli, G, Ciapetti, M, Sani, G, Batacchi, S, Biondi, S, Bernardo, P, Lazzeri, C, Giovannini, V, Azzi, A, Abbate, R, Gensini, G & Peris, A 2011, 'Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure: Results of an Italian referral ECMO center', BMC Pulmonary Medicine, vol. 11, 2. https://doi.org/10.1186/1471-2466-11-2
Cianchi, Giovanni ; Bonizzoli, Manuela ; Pasquini, Andrea ; Bonacchi, Massimo ; Zagli, Giovanni ; Ciapetti, Marco ; Sani, Guido ; Batacchi, Stefano ; Biondi, Simona ; Bernardo, Pasquale ; Lazzeri, Chiara ; Giovannini, Valtere ; Azzi, Alberta ; Abbate, Rosanna ; Gensini, Gianfranco ; Peris, Adriano. / Ventilatory and ECMO treatment of H1N1-induced severe respiratory failure : Results of an Italian referral ECMO center. In: BMC Pulmonary Medicine. 2011 ; Vol. 11.
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abstract = "Background: Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.Methods: Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.Results: A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100{\%} sensitivity compared to 75{\%} from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3{\%}.Conclusions: In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.",
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AU - Pasquini, Andrea

AU - Bonacchi, Massimo

AU - Zagli, Giovanni

AU - Ciapetti, Marco

AU - Sani, Guido

AU - Batacchi, Stefano

AU - Biondi, Simona

AU - Bernardo, Pasquale

AU - Lazzeri, Chiara

AU - Giovannini, Valtere

AU - Azzi, Alberta

AU - Abbate, Rosanna

AU - Gensini, Gianfranco

AU - Peris, Adriano

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N2 - Background: Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance.Methods: Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination.Results: A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%.Conclusions: In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.

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