Management of Severe Influenza

2021 ◽  
Vol 42 (06) ◽  
pp. 771-787
Author(s):  
Liam S. O'Driscoll ◽  
Ignacio Martin-Loeches
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Point Of Care ◽  
Influenza Infection ◽  
Treatment Options ◽  
Evidence Base ◽  
Diagnosis And Treatment ◽  
Severe Illness ◽  
Severe Influenza ◽  
Severe Acute Respiratory Infection

AbstractInfluenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.

scholarly journals Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakub Smiechowicz ◽  
Barbara Barteczko-Grajek ◽  
Barbara Adamik ◽  
Jozef Bojko ◽  
Waldemar Gozdzik ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Organ Failure ◽  
Intensive Care Units ◽  
Sofa Score ◽  
Influenza Infection ◽  
Winter Season ◽  
Respiratory Support ◽  
Costly Treatment ◽  
High Degree

Abstract Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure.

IFITM3 rs12252 T>C polymorphism is associated with the risk of severe influenza: a meta-analysis

2015 ◽  
Vol 143 (14) ◽  
pp. 2975-2984 ◽  
Author(s):  
Y. XUAN ◽  
L. N. WANG ◽  
W. LI ◽  
H. R. ZI ◽  
Y. GUO ◽  
...  
Keyword(s):  
Influenza A ◽  
Web Of Science ◽  
Transmembrane Protein ◽  
Influenza Infection ◽  
Meta Analysis ◽  
Severe Illness ◽  
Severe Influenza ◽  
Increased Risk ◽  
Interferon Pathway ◽  
Comprehensive Literature Search

SUMMARYThe interferon-inducible transmembrane protein 3 (IFITM3), as one of the key genes involved in the interferon pathway, is critical for defending the host against influenza virus, and the rs12252 T>C variant in IFITM3 might be associated with susceptibility to severe influenza. Owing to contradictory and inconclusive results, we performed a meta-analysis to assess the association between rs12252 T>C polymorphism and severe influenza risk. A comprehensive literature search up to 1 August 2014 was conducted in EMBASE, Pubmed, Web of Science, VIP, Wanfang and CNKI databases. Four eligible studies with a total of 445 influenza patients and 3396 controls were included in this meta-analysis. Overall, our results demonstrated a significant association between the IFITM3 rs12252 T>C polymorphism and influenza risk [C vs. T: odds ratio (OR) 1·68, 95% confidence interval (CI) 1·32–2·13; CC vs. CT+TT: OR 2·38, 95% CI 1·52–3·73; CC+CT vs. TT: OR 1·62, 95% CI 1·18–2·22]. Stratification by ethnicity indicated that the variant C allele was associated with an 88% increased risk of influenza in Asians (C vs. T: OR 1·88, 95% CI 1·34–2·62). Moreover, subjects carrying the variant C allele had an increased risk of developing severe illness upon influenza infection (C vs. T: OR 2·70, 95% CI 1·86–3·94). However, no significant association was observed in patients with mild infection (C vs. T: OR 1·26, 95% CI 0·93–1·71). Our meta-analysis suggests that IFITM3 rs12252 T>C polymorphism is significantly associated with increased risk of severe influenza but not with the chance of initial virus infection.

scholarly journals Clinical Progress Note: Point-of-Care Ultrasound Applications in COVID-19

2020 ◽  
Vol 15 (6) ◽  
pp. 353-355 ◽  
Author(s):  
Benji K Mathews ◽  
Seth Koenig ◽  
Linda Kurian ◽  
Benjamin Galen ◽  
Gregory Mints ◽  
...  
Keyword(s):  
Septic Shock ◽  
Respiratory Failure ◽  
Critical Illness ◽  
Literature Search ◽  
Point Of Care ◽  
Severe Illness ◽  
Point Of Care Ultrasound ◽  
The Novel ◽  
Novel Coronavirus ◽  
Ultrasound Applications

COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, was declared a pandemic on March 11, 2020. Although most patients (81%) develop mild illness, 14% develop severe illness, and 5% develop critical illness, including acute respiratory failure, septic shock, and multiorgan dysfunction.1 Point-of-care ultrasound (POCUS), or bedside ultrasound performed by a clinician caring for the patient, is being used to support the diagnosis and serially monitor patients with COVID-19. We performed a literature search of electronically discoverable peer-reviewed publications on POCUS use in COVID-19 from December 1, 2019, to April 10, 2020. We review key POCUS applications that are most relevant to frontline providers in the care of COVID-19 patients.

scholarly journals Smoking and Comorbidities in Covid-19: A Systematic Review

2020 ◽  
Vol 9 (2) ◽  
pp. 117-125
Author(s):  
Andri Nugraha ◽  
Ernawati Ernawati ◽  
Tuti Anggriani Utama ◽  
Santi Rinjani
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
High Risk ◽  
Full Text ◽  
Severe Disease ◽  
Severe Illness ◽  
Severe Infections

COVID-19 is highly contagious, causing pneumonia, respiratory failure, death, and becoming a pandemic. Patients with severe infections must be treated in the Intensive Care Unit (ICU) with a ventilator. Ventilator facilities in the ICU are limited; it must take precautions by knowing the characteristics of patients at high risk of severe disease in COVID-19, one of which was smoking or comorbidity. The purpose of this study was to assess the risk of comorbidity and smoking in COVID-19. This study used systematic review by searching for articles from the ScienceDirect and Medline databases with journals published on January 1, 2019 - March 31, 2020. The results of the study showed that there were 12 relevant articles full text in English and were analysed. The conclusion was that patients with COVID-19 who were smoking or had comorbidities were more susceptible to COVID-19 infection, more severe illness, and causing death.

scholarly journals Intensive care unit surveillance of influenza infection in France: the 2009/10 pandemic and the three subsequent seasons

2015 ◽  
Vol 20 (46) ◽  
Author(s):  
Isabelle Bonmarin ◽  
Emmanuel Belchior ◽  
Jean Bergounioux ◽  
Christian Brun-Buisson ◽  
Bruno Mégarbane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Intensive Care ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Influenza Infection ◽  
Winter Season ◽  
Clinical Severity ◽  
Factors Associated ◽  
Severe Influenza

During the 2009/10 pandemic, a national surveillance system for severe influenza cases was set up in France. We present results from the system's first four years. All severe influenza cases admitted to intensive care units (ICU) were reported to the Institut de Veille Sanitaire using a standardised form: data on demographics, immunisation and virological status, risk factors, severity (e.g. acute respiratory distress syndrome (ARDS) onset, mechanical ventilation, extracorporeal life support) and outcome. Multivariate analysis was performed to identify factors associated with ARDS and death. The number of confirmed influenza cases varied from 1,210 in 2009/10 to 321 in 2011/12. Most ICU patients were infected with A(H1N1)pdm09, except during the 2011/12 winter season when A(H3N2)-related infections predominated. Patients' characteristics varied according to the predominant strain. Based on multivariate analysis, risk factors associated with death were age ≥ 65 years, patients with any of the usual recommended indications for vaccination and clinical severity. ARDS occurred more frequently in patients who were middle-aged (36–55 years), pregnant, obese, or infected with A(H1N1)pdm09. Female sex and influenza vaccination were protective. These data confirm the persistent virulence of A(H1N1)pdm09 after the pandemic and the heterogeneity of influenza seasons, and reinforce the need for surveillance of severe influenza cases.

scholarly journals Highlights from the Respiratory Failure and Mechanical Ventilation 2020 Conference

2021 ◽  
Vol 7 (1) ◽  
pp. 00752-2020
Author(s):  
Adelaide Withers ◽  
Tiffany Choi Ching Man ◽  
Rebecca D'Cruz ◽  
Heder de Vries ◽  
Christoph Fisser ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Patient Selection ◽  
Treatment Options ◽  
Early Career ◽  
European Respiratory Society ◽  
Diagnostic Strategies ◽  
Adults And Children ◽  
International Experts

The Respiratory Intensive Care Assembly of the European Respiratory Society organised the first Respiratory Failure and Mechanical Ventilation Conference in Berlin in February 2020. The conference covered acute and chronic respiratory failure in both adults and children. During this 3-day conference, patient selection, diagnostic strategies and treatment options were discussed by international experts. Lectures delivered during the event have been summarised by Early Career Members of the Assembly and take-home messages highlighted.

scholarly journals Based on network pharmacology and molecular docking to explore the Traditional Chinese Medicine anti-influenza mechanisms:Chinese protocol for diagnosis and treatment of influenza.

2020 ◽  
Author(s):  
yifei Chen
Keyword(s):  
Molecular Docking ◽  
Influenza A ◽  
Influenza Infection ◽  
Diagnosis And Treatment ◽  
Network Pharmacology ◽  
Ppi Network ◽  
Active Components ◽  
Pharmacological Mechanism ◽  
Severe Influenza ◽  
Target Network

Background Explore the possible mechanism of anti-influenza virus, based on the study of the active components-drug-target network, Protein-Protein Interaction (PPI) network and molecular docking verification, we explored the potential action mechanism of TCM in Chinese protocol for diagnosis and treatment of influenza 2019. Methods Screening the active components and potential targets of 12 drugs in the scheme by using TCMSP database, and Obtaining the target of influenza by GeneCard, Durgbank, OMIM, TTD and PharmGkb databases. Then, constructed the “component-durg-target” network and PPI network were by Cytoscape3.8.0 software. Morethan, analyzed and the biological function and pathway, verified the molecular docking by AutoDock Vina software. Results The 12 drugs in the recommended scheme (XBCQ) for severe influenza contain 192 active components and involve 31 key antiviral targets, which may play an antiviral role through biological processes such as lipopolysaccharide, pathogen molecular reaction and regulate signaling pathway via the IL-17, influenza A, TNF, Toll-like receptors. Conclusion TCM play critical therapeutic roles through “multi-components, multi-targets and multi-pathways” mechanisms in influenza infection. The antiviral pharmacological mechanism of Xuanbai Chengqi decoction, which was analyzed by network pharmacology and molecular docking, provide a new idea for further exploring the diagnosis and treatment of severe influenza.

scholarly journals Outcomes and characteristics of COVID-19 patients treated with CPAP/ HFNO outside of the intensive care setting

2021 ◽  
pp. 00318-2021
Author(s):  
Dominic L Sykes ◽  
Michael G Crooks ◽  
Khaing Thu Thu ◽  
Oliver I Brown ◽  
Theodore J p Tyrer ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Care Setting ◽  
Treatment Options ◽  
Invasive Mechanical Ventilation ◽  
Respiratory Support ◽  
Intensive Care Setting ◽  
Non Invasive ◽  
Significant Difference

BackgroundContinuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO) have been used to manage hypoxaemic respiratory failure secondary to COVID-19 pneumonia. Limited data are available for patients treated with non-invasive respiratory support outside of the intensive care setting.MethodsIn this single-centre observational study we observed the characteristics, physiological observations, laboratory tests, and outcomes of all consecutive patients with COVID-19 pneumonia between April 2020 and March 2021 treated with non-invasive respiratory support outside of the intensive care setting.ResultsWe report the outcomes of 140 patients (Mean Age=71.2 [sd=11.1], 65% Male [n=91]) treated with CPAP/HFNO outside of the intensive care setting. Overall mortality was 59% and was higher in those deemed unsuitable for mechanical ventilation (72%). The mean age of survivors was significantly lower than those who died (66.1 versus 74.4 years, p<0.001). Those who survived their admission also had a significantly lower median Clinical Frailty Score than the non-survivor group (2 versus 4, p<0.001). We report no significant difference in mortality between those treated with CPAP (n=92, mortality: 60%) or HFNO (n=48, mortality: 56%). Treatment was well tolerated in 86% of patients receiving either CPAP or HFNO.ConclusionsCPAP and HFNO delivered outside of the intensive care setting are viable treatment options for patients with hypoxaemic respiratory failure secondary to COVID-19 pneumonia, including those considered unsuitable for invasive mechanical ventilation. This provides an opportunity to safeguard intensive care capacity for COVID-19 patients requiring invasive mechanical ventilation.

scholarly journals Pseudo-safety in a cohort of patients with COVID-19 discharged home from the emergency department

2021 ◽  
pp. emermed-2020-210041
Author(s):  
Neal Yuan ◽  
Hongwei Ji ◽  
Nancy Sun ◽  
Patrick Botting ◽  
Trevor Nguyen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Point Of Care ◽  
Severe Illness ◽  
Resource Limited ◽  
History Of ◽  
Hospital Stays ◽  
Adjusted Model ◽  
Information History

IntroductionEDs are often the first line of contact with individuals infected with COVID-19 and play a key role in triage. However, there is currently little specific guidance for deciding when patients with COVID-19 require hospitalisation and when they may be safely observed as an outpatient.MethodsIn this retrospective study, we characterised all patients with COVID-19 discharged home from EDs in our US multisite healthcare system from March 2020 to August 2020, focusing on individuals who returned within 2 weeks and required hospital admission. We restricted analyses to first-encounter data that do not depend on laboratory or imaging diagnostics in order to inform point-of-care assessments in resource-limited environments. Vitals and comorbidities were extracted from the electronic health record. We performed ordinal logistic regression analyses to identify predictors of inpatient admission, intensive care and intubation.ResultsOf n=923 patients who were COVID-19 positive discharged from the ED, n=107 (11.6%) returned within 2 weeks and were admitted. In a multivariable-adjusted model including n=788 patients with complete risk factor information, history of hypertension increased odds of hospitalisation and severe illness by 1.92-fold (95% CI 1.07 to 3.41), diabetes by 2.20-fold (1.18 to 4.02), chronic lung disease by 2.21-fold (1.22 to 3.92) and fever by 2.89-fold (1.71 to 4.82). Having at least two of these risk factors increased the odds of future hospitalisation by 6.68-fold (3.54 to 12.70). Patients with hypertension, diabetes, chronic lung disease or fever had significantly longer hospital stays (median 5.92 days, 3.08–10.95 vs 3.21, 1.10–5.75, p<0.01) with numerically higher but not significantly different rates of intensive care unit admission (27.02% vs 14.30%, p=0.27) and intubation (12.16% vs 7.14%, p=0.71).DiscussionPatients infected with COVID-19 may appear clinically safe for home convalescence. However, those with hypertension, diabetes, chronic lung disease and fever may in fact be only ‘pseudo-safe’ and are most at risk for subsequent hospitalisation with more severe illness and longer hospital stays.

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