Infl uenza A(H1N1) • Average volume assured pressure support
Brief History of Novel Pandemic Influenza A H1N1The fi rst cases of the novel infl uenza A(H1N1) virus were reported in April 2009, especially in Mexico and the United States [ 1 , 2 ]. The disease spread rapidly, becoming a pandemic by June 2009. On August 21, 2009, a total of 177 reported cases of novel infl uenza 182.166 A(H1N1) infection, of which 1,799 were fatal [ 2 ]. It has been observed in animal studies that the novel infl uenza virus A has a high replication rate in lung tissue, with a great capacity to invade the lower respiratory tract in humans, causing especially acute fulminant respiratory failure.The acute respiratory failure (ARF) in patients with novel H1N1 disease-its most severe form of presentation-includes diffuse pulmonary infi ltrates and severely compromised oxygenation. The alveolar-arterial gradient of oxygen is also compromised once the acute respiratory syndrome (ARDS) is established.Studies on the management of patients with ARF and infection with novel H1N1 infl uenza are based on the most severe form of respiratory failure, multiple pulmonary infi ltrates, PaO 2 /FiO 2 > 200, and even severe multiple organ damage.Novel H1N1 infl uenza infection is a disease whose lethality is based on the presence of progressive ARF for 48-72 h after presentation of the disease. Hence, there is a period during which the disease is becoming established and therefore when early intervention could halt its progression, thereby reducing its morbidity and mortality.