Saturday, 11 July 2009

Characteristics of Swine Flu patients admitted to ICU

July 10. The CDC has published a case series of ten patients that required ICU admission due to Swine Flu infection (H1N1). The Flu season has just commenced in the southern hemisphere.

The patient's had characteristics that are unusual and unexpected.
  • The ages ranged from 21 to 53 years
  • Seven were previously well - only three had underlying conditions
  • Nine of the ten patients were obese (BMI>30)
  • Five had pulmonary emboli. Two others had a hyper-coagulable state.
  • Nine developed Multiorgan Dysfunction Syndrome
  • All required advanced forms of ventilation
  • Two needed ECMO
  • Six needed renal replacement therapy
  • Nine needed vasopressor Rx for sepsis
  • All ten patients had high dose antiviral drug treatment.
  • Five have recovered to leave ICU, but 3 have died.
The report recommends:

"In communities in which novel influenza A (H1N1) virus is the predominant circulating influenza virus, oseltamivir or zanamivir should be administered as early as possible to hospitalized patients with suspected novel influenza A (H1N1) virus infection, even before diagnostic testing results are available. "


  1. What is the Westmead dept's approach to elective surgical patients during the H1N1 epidemic? Are you screening patients more rigorously through preop phone calls for example?

  2. Are you finding similar characteristics at Westmead ICU? I've had a run of young hypoxic patients without elevated WCCs (but with high CRPs) come through ED recently, and they've gone to the ward (but I don't know if they needed subsequent ICU admission). Is hypoxia without leukocytosis/neutrophilia a characteristic of H1N1?