[Treatment of critically ill influenza A H1N1 patients in plateau region].

Objective: To discuss the strategy of treatment of critically ill influenza A H1N1 patients in plateau region.

Methods: Four seriously ill and 4 critically ill patients suffering from influenza A H1N1 were admitted to the intensive care unit during October 10th through December 19th 2009. They were treated with antivirus drug, antibiotics, corticosteroid, measures to enhance immune function, fluid and electrolyte supplementation, symptomatic treatment, and mechanical ventilation. With their clinical data the distinguishing features in the treatment of these patients were analyzed.

Results: Oseltamivir as an antivirus drug, and moxifloxacin together with ceftriaxone or cefoperazone were given to all the patients. Fluid replacement was controlled to avoid over hydration. Corticosteroid was administered to 3 seriously ill patients and 3 critically ill patients. Methylprednisolone was given to 1 critically ill patient. gamma-globulin was given to 7 patients. Four patients underwent atraumatic mechanical ventilation with bi-level positive airway pressure (BiPAP) or continuous positive airway pressure (CPAP) with good result. Owing to deterioration in respiratory function, traumatic mechanical ventilation was instituted in a critically ill patient, primarily with synchronized intermittent mandatory ventilation (SIMV)+pressure support ventilation (PSV)+high positive end expiratory pressure (PEEP). The condition of the patient was improved, and ventilation modality was changed to spontaneous respiration+PSV+low PEEP before weaning. Finally the patient was weaned from respirator successfully. All the 8 patients survived and discharged from the hospital.

Conclusion: Short term, full dosage of corticosteroid should be given to seriously ill and critically ill influenza A H1N1 patients according to specification, and atraumatic mechanical ventilation should be installed early in the treatment.