H1n1 Influenza: A Virus-Associated Acute Respiratory Distress Syndrome: Response to Combination Oseltamivir and Prolonged Corticosteroid Treatment

Quispe-Laime, Adolfo Maximo; Bracco, Jonas Daniel; Barberio, P.A.; Campagne, Claudio German; Rolfo, Verónica Edith; Umberger, Reba; Meduri, G. Umberto

doi:10.1378/chest.136.4_meetingabstracts.47s-h

Cited by 3 publications

(1 citation statement)

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“…However, this therapy might be considered within the context of other salvage therapies for respiratory failure. For example, if hypoxemia (e.g., PaO2 < 55 mmHg) persists despite optimal mechanical ventilation and use of other less invasive rescue therapies (inhaled nitric oxide/prostacyclin, prone positioning, neuromuscular blockade, corticosteroids) (29), there may be benefit to considering ECMO. It is worth noting that these less invasive rescue therapies, which are often used before ECMO (4), may improve oxygenation, yet have no demonstrable mortality benefit either.…”

Section: Discussionmentioning

confidence: 99%

A systematic review to inform institutional decisions about the use of extracorporeal membrane oxygenation during the H1N1 influenza pandemic*

Mitchell

Mikkelsen

Umscheid

et al. 2010

Critical Care Medicine

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Objective To systematically evaluate the effect of extracorporeal membrane oxygenation (ECMO) on survival in adults with acute respiratory failure (ARF), to help inform institutional decisions about implementing an ECMO program or transferring patients to experienced ECMO centers during the H1N1 influenza pandemic. Data Sources National Guideline Clearinghouse, Medline, EMBASE, AHRQ Evidence-based Practice reports, National Institute for Health and Clinical Excellence, Cochrane Library, International Network of Agencies for Health Technology Assessment, citation review. Study Selection Studies of ECMO in adult ARF, reporting mortality rates for at least 10 patients in ECMO and non-ECMO groups. Data Extraction Mortality rates were abstracted for all patients and for influenza patients. Risk ratios were meta-analyzed using random-effects methods and assessed for heterogeneity. Data Synthesis There are no evidence-based clinical guidelines on the use of ECMO in influenza patients. Three randomized controlled trials and three cohort studies evaluated ECMO in ARF patients; none reported specifically on influenza patients. Meta-analysis of the RCTs revealed significant heterogeneity in risk of mortality. The summary risk ratio found by the meta-analysis was 0.93 [95% confidence interval (CI): 0.71 – 1.22]. The most recent trial found a reduction in mortality and severe disability at 6 months among patients in whom ECMO was considered. Observational studies suggest that ECMO for ARF due to viral pneumonia is associated with improved mortality compared with other etiologies of ARF. Conclusions The best evidence to guide decisions regarding the use of ECMO for influenza patients stems from trials of ECMO for ARF of all etiologies, among which significant heterogeneity exists, and from case series describing outcomes of ECMO in patients with influenza. Thus, there is insufficient evidence to provide a recommendation for ECMO use among patients with respiratory failure due to influenza. However, clinicians should consider ECMO within the context of other salvage therapies for ARF.

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Section: Discussionmentioning

confidence: 99%