Clinical Management of Pandemic (H1N1) Infection.
Chest. 2009 Dec 18;
Authors: Hui DS, Lee N, Chan PK
Antiviral therapy and vaccination are important strategies for controlling pandemic (H1N1) 2009 influenza but efficacy depends on the timing of administration and is often limited by shortage of supply. Patients with dyspnea, tachypnea, evidence of hypoxemia and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with acute respiratory distress syndrome. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in SARS and H3N2 infection. Low dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyper-immune globulin may be explored as rescue therapy. More data are needed to explore the potential role of intravenous gammaglobulin and other drugs with immuno-modulating properties such as statins, gemfibrozil, and N-acetyl-cysteine. Healthcare workers must apply strict standard and droplet precautions when dealing with suspected and confirmed cases, and upgrade to airborne precautions when performing aerosol-generating procedures. Non-pharmacological measures such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.
PMID: 20022969 [PubMed - as supplied by publisher]