Severe Manifestations of H1N1

1
Severe Manifestations of H1N1

• Michelle Harkins, MD
• UNMH

2
Epidemiology

• H1N1 in multiple countries (177)
• 20-25 have required ICU level care
• Australia reported 40 of their ICU beds were
  full with H1N1 patients.
• Spanish cohort of 32 ICU level patients in 5
  weeks with case fatality rate 25.

3
Common complaints

• Fever
• Cough
• Myalgias
• Headache
• Sore throat
• Sudden onset of symptoms
• Malaise

4
Pulmonary Problems

• Primary viral pneumonitis
• Virus attacks lower respiratory tract more than
  seasonal flu
• Hemorrhagic secretions
• Multilobar infiltrates seen on CXR
• Severe hypoxemia
• Secondary bacterial pneumonia
• Exacerbation of underlying pulmonary disease may
  worsen the course of disease

5
Potential Severe Manifestations

• Respiratory failure
• Requiring alternative modes of mechanical
  ventilation APRV, High frequency oscilllator
• Not severe compliance problems
• Develop severe ARDS
• Pancytopenia
• Multi-organ failure
• Encephalitis and other neurologic complications
• Myocarditis/pericarditis

6
Treatment

• Droplet precautions
• CDC recommendations with face mask vs N95
• Sending several swabs and BAL for diagnostics
• Oseltamivir for minimum of 7 days
• Tricor can now perform PCR for H1N1 on
  hospitalized patients with 24 hour turnaround

7
UNM MICU

• Patients with confirmed H1N1 12
• 33 of our MICU census currently
• Age range 21-51
• Deaths 2
• Duration of mechanical ventilation
• Minimum of 2-3 weeks
• Pressor requirement in majority initially
• Predisposing conditions
• Obesity
• HIV, CP