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1/11/10

1/11/10. 1/14/10. 1/16/10. Alisa Alker. Treatment: who, what, when?. Who should be treated. CDC recommendations of who should be treated illness requiring hospitalization progressive, severe illness, regardless of previous health status

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1/11/10

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  1. 1/11/10

  2. 1/14/10

  3. 1/16/10

  4. Alisa Alker

  5. Treatment: who, what, when?

  6. Who should be treated • CDC recommendations of who should be treated • illness requiring hospitalization • progressive, severe illness, regardless of previous health status • risk factors for severe illness, such as chronic pulmonary disease, CV disease, malignancy, chronic renal insufficiency, chronic liver disease, DM, and hemoglobinopathies such as sickle cell, HIV or other immunosuppressive states, rheumatological disorders, any individual who might have problems handling their own secretions, and obesity* • Consider treating if a mild disease in someone with no risk factors in whom the symptoms started <48 hours ago

  7. Treatment choices • neuraminidase inhibtors • oseltamivir- 75 mg po BID • zanamivir- inhaled • peramivir- IV (investigational) • rimantadine and amantadine

  8. ECMO • retrospective analysis of patients with confirmed H1N1 placed on ECMO (n=61) and with mechanical ventilation (n=133) • pts on ECMO tended to be younger, more hypoxic, and more sick • mortality: ECMO 23% mech. vent. 14%

  9. Influenza in NC http://www.epi.state.nc.us/epi/gcdc/flu0910.html

  10. References 1.Davies A, Jones D, Bailey M, Beca J, Bellomo R, Blackwell N, et al. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1N1) Acute Respiratory Distress Syndrome. JAMA. 2009 Nov 4;302(17):1888-1895. 2.Domínguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically Ill patients with 2009 influenza A(H1N1) in Mexico. JAMA. 2009 Nov 4;302(17):1880-1887. 3.Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009 Nov 4;302(17):1872-1879. 4.Lee C, Lee J. Dynamics of clinical symptoms in patients with pandemic influenza A (H1N1). Clinical Microbiology and Infection. 2010 4;16(4):389-390. 5.Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California. JAMA. 2009 Nov 4;302(17):1896-1902. 6.CDC H1N1 Flu | Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season [Internet]. [cited 2010 Mar 17];Available from: http://www.cdc.gov.libproxy.lib.unc.edu/H1N1flu/recommendations.htm

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