H1N1 flu — report from the trenches of one PICU

The H1N1 strain of influenza — the “swine flu” — has gotten a lot of headlines this past year. You can find a summary of matters during the first half of 2009 here. That report studied 272 patients who were sick enough to be admitted to the hospital. Of these, 25% needed to be in the ICU. From my perspective, the interesting part was that nearly half were children; unlike usual influenza epidemics, only 5% were older than 65.

I didn’t see any severe cases of H1N1 until this past fall, but then I began to see quite a few of them. Of these, two were so severe that they required prolonged treatment with a mechanical ventilator, a breathing machine. Another child in our region was so severely ill that he required treatment with the most extreme kind of respiratory support, something called extracorporeal membrane oxygenation (ECMO). This machine bypasses the lungs entirely and uses a machine to get oxygen directly into the child’s bloodstream. Using ECMO is a complicated endeavor, one with high risks and high mortality. But sometimes it is all we have to offer.

My conclusion on the H1N1 flu is that it was every bit as severe as the experts predicted. Although the mortality was not anywhere near as bad as the great epidemic of 1918, we also have means of ICU support that physicians didn’t have back then. This year’s flu, like that of 1918, also seemed to affect the very young to a degree I haven’t seen before. To me, the massive campaign to vaccinate as many as possible was justified. Of course we don’t know if it helped reign in the epidemic thus far, but I think it probably has.


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