Related Articles

Extracorporeal membrane oxygenation (ECMO) in patients with H1N1 influenza infection: a systematic review and meta-analysis including 8 studies and 266 patients receiving ECMO.

Crit Care. 2013 Feb 13;17(1):R30

Authors: Zangrillo A, Biondi-Zoccai G, Landoni G, Frati G, Patroniti N, Pesenti A, Pappalardo F

Abstract
ABSTRACT: INTRODUCTION: H1N1 influenza can cause severe acute lung injury (ALI). Extracorporeal membrane oxygenation (ECMO) can support gas exchange in patients failing conventional mechanical ventilation, but its role is still controversial. We conducted a systematic review and meta-analysis on ECMO for H1N1-associated ALI. METHODS: CENTRAL, Google Scholar, MEDLINE/PubMed, and Scopus (updated January 2, 2012) were systematically searched. Studies reporting on 10 or more patients with H1N1 infection treated with ECMO were included. Baseline, procedural, outcome and validity data were systematically appraised and pooled, when appropriate, with random-effect methods. RESULTS: From 1196 initial citations, 8 studies were selected, including 1357 patients with confirmed/suspected H1N1 infection requiring intensive care unit admission, 266 (20%) of whom were treated with ECMO. Patients had a median SOFA score of 9, and had received mechanical ventilation before ECMO implementation for a median of 2 days. ECMO was implanted before inter-hospital patient transfer in 72% of cases and in most patients (94%) the veno-venous configuration was used. ECMO was maintained for a median of 10 days. Outcomes were highly variable among the included studies, with in-hospital or short-term mortality ranging between 8% and 65%, mainly depending on baseline patient features. Random-effect pooled estimates suggested an overall in-hospital mortality of 28% (95% confidence interval 18%-37%; I2=64%). CONCLUSIONS: ECMO is feasible and effective in patients with ALI due to H1N1 infection. Despite this, prolonged support (>1 week) is required in most cases, and subjects with severe comorbidities or multiorgan failure remain at high risk of in-hospital death.

PMID: 23406535 [PubMed - as supplied by publisher]

Pandemic Management in a Pediatric Hospital.

Clin Pediatr (Phila). 2013 Feb 12;

Authors: Ratnapalan S, Martimianakis MA, Cohen-Silver JH, Minnes B, Macgregor D, Allen U, Richardson SE, Friedman JN, Bruce-Barrett C, Haj-Assaad L, Noordermeer J, Daneman D

Abstract
Objectives. To describe our experiences in the management of the second wave of influenza A H1N1 (pH1N1) pandemic in a tertiary-care children's hospital. Methods. An autoethnographic study of the pandemic planning and management committee members involved in managing the second wave of pH1N1 was conducted. Results. Staffing, surge capacity, communications and emergency operations planning by adding leaders of frontline workers and other key operational roles to the incident management team, and creating a tactical response team emerged as important factors in pandemic management in our hospital. The emergency department visits increased by 50%, necessitating increased staffing of the emergency department. Communications using existing chains of command had to be used to reach frontline staff during the pandemic. Conclusions. Incident management teams managing pandemics and other disasters have to be dynamic and create tactical teams to ensure implementation and facilitate bidirectional communication with frontline workers.

PMID: 23406719 [PubMed - as supplied by publisher]

Influenza Aerosols in UK Hospitals during the H1N1 (2009) Pandemic - The Risk of Aerosol Generation during Medical Procedures.

PLoS One. 2013;8(2):e56278

Authors: Thompson KA, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, Nguyen-Van-Tam JS, Copley VR, O'Brien S, Hoffman P, Parks S, Bentley A, Isalska B, Thomson G, EASE Study Consortium

Abstract
BACKGROUND: Nosocomial infection of health-care workers (HCWs) during outbreaks of respiratory infections (e.g. Influenza A H1N1 (2009)) is a significant concern for public health policy makers. World Health Organization (WHO)-defined 'aerosol generating procedures' (AGPs) are thought to increase the risk of aerosol transmission to HCWs, but there are presently insufficient data to quantify risk accurately or establish a hierarchy of risk-prone procedures.
METHODOLOGY/PRINCIPAL FINDINGS: This study measured the amount of H1N1 (2009) RNA in aerosols in the vicinity of H1N1 positive patients undergoing AGPs to help quantify the potential risk of transmission to HCWs. There were 99 sampling occasions (windows) producing a total of 198 May stages for analysis in the size ranges 0.86-7.3 µm. Considering stages 2 (4-7.3 µm) and 3 (0.86-4 µm) as comprising one sample, viral RNA was detected in 14 (14.1%) air samples from 10 (25.6%) patients. Twenty three air samples were collected while potential AGPs were being performed of which 6 (26.1%) contained viral RNA; in contrast, 76 May samples were collected when no WHO 2009 defined AGP was being performed of which 8 (10.5%) contained viral RNA (unadjusted OR = 2.84 (95% CI 1.11-7.24) adjusted OR = 4.31 (0.83-22.5)).
CONCLUSIONS/SIGNIFICANCE: With our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI) = 4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams.

PMID: 23418548 [PubMed - in process]

Advances in antibiotic therapy for community-acquired pneumonia.

Curr Opin Pulm Med. 2013 Feb 15;

Authors: Viasus D, Garcia-Vidal C, Carratalà J

Abstract
PURPOSE OF REVIEW: Community-acquired pneumonia (CAP) is a major public health problem all over the world. The increasing number of antibiotic-resistant bacteria is a matter of concern for physicians when choosing antibiotic treatment in patients with CAP. This review focuses on the current recommendations of antibiotic treatment, recent information concerning antibiotic resistance of pathogens, and the advances in antibiotic therapy in the field of CAP. RECENT FINDINGS: A significant increase in the frequency of resistance to the antibiotics commonly used against causative pathogens of CAP, such as β-lactams or macrolides, has been reported in recent years. At present, the prevalence of fluoroquinolone resistance in Streptococcus pneumoniae remains low. Community-acquired methicillin-resistant Staphylococcus aureus and influenza A(H1N1)pdm09 have been reported as causes of severe CAP. Several newly-developed antibiotics, including cepholosporins, ketolides and quinolones, present marked activity in vitro against the main causative pathogens of CAP. Many randomized controlled trials have demonstrated equivalent efficacy of the newer antibiotics compared with conventional antimicrobial therapy in mild-to-moderate CAP. SUMMARY: An increase of resistance to the antibiotics used in CAP has been documented over the years. Several new antibiotics have been developed for treating CAP, with promising results. However, data regarding their efficacy and safety in patients with severe CAP are lacking.

PMID: 23422416 [PubMed - as supplied by publisher]