Pandemic influenza: intensive care management of adults and children

The clinical course of pandemic H1N1 infection has been quite different from seasonal influenza infection. It has mostly affected young and healthy population. Depending on outbreak’s course till today and the previous outbreaks 12-30% of the population was expected to become ill and among them 4% was expected to be hospitalised throughout the pandemic. It was estimated for all intensive care unit (ICU) beds to be occupied with patients infected with H1N1 virus in the first period of the pandemic. Fortunately, without being confronted with this situation, pandemic has been milder than expected. Any how, in southern hemisphere as in Australia and New Zeland which were affected first after the breakdown of outcome, 25% of ICU beds were occupied with patients probably or certainly infected with H1N1. Presence of an underlying chronic disease (especially respiratory comorbidities lika chronic obstructive lung disease and asthma, obesity, cigarette smoking, diabetes mellitus) is the major determinant of ICU need during influenza infection. The most important problem in critical H1N1 patients is the need for mechanical ventilation due to acute respiratory failure. The causes of acute respiratory failure are reported to be acute respiratory distress syndrome characterised by bilateral alveolar infiltration secondary to acute viral pneumonia, secondary bacterial pneumonia, asthma or chronic obstructive lung disease exacerbation characterised with bronchospasm, excacerbation of the underlying disease such as congestive heart failure and croup/bronchiolitis in children. In this review, treatment strategies including medical treatment and mechanical ventilation have been discussed in these patients. It is necessary to evaluate the possible increase in ICU requirement during the preparation period for pandemics. However, defficiencies in ICU numbers and insufficiencies in the infrastructure of ICUs are an important problem in our country. Admission to ICUs, treatment plan in the ICU and the rational use of resources are very important in these patients. For this reason, it is necessary to build up a data base and to analyse these data with a qualified recording system.