15. Ulusal Dahili ve Cerrahi Bilimler Yoğun Bakım Kongresi

7. Avrasya Yoğun Bakım Toplantısı


 
H1N1: ACUTE LUNG INJURY: TİMİNG OF THERAPY İN İCU AND SURPRİSİNG PREDİSPOSİNG FACTORS
ERTAY BORAN 1 MERTAY BORAN 2

1- Düzce Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Kliniği
2- Düzce Üniversitesi Tıp Fakültesi, Göğüs Cerrahisi Kliniği
 
Özet:

Backround: Rapidly progressive pneumonia leading to acute lung injury (ALI)-acute respiratory distress syndrome (ARDS) with high mortality was developed in minority of patients due to influenza infection. We reported H1N1-acute lung injury and it treatment in two young healthy adults. Case: The first case, 34 year old male patient with severe acute respiraory failure was admited to ICU. The patient was hospitalised with progresively worsened fever, couphing and dispnea lasting for one week. Severe pneumonia was first considered and antibiotics were started (levofloxacin,vancomycin) empirically and O2 was given through nasal canula. The clinic progressed to severe dyspnea in hours and after short Non-invasive ventilatory(NİV) support patient was entubated and accepted to ICU with severe ARDS. Oseltamivir 75mg x2 and Puls streoid therapy(1gr/day) was added to antibiotics and patient mechnicaly ventilated. With no reply to the theapy the patient was sceduled to ECMO therapy and transferred to differrent ICU center where the same medical therapy continued under ECMO support. After a few weeks therapy patient clinics impoved. The second case was 33 female patient with same clinic. After symptoms of fever, couphyng for a week she was accepted to our ICU with ALİ-ARDS. The therapy of oseltamivir, vancomycin, levofloxasin, puls streoid(1 gr/day) and NİV was started. In a few days the patient’s clinic improved. The culture results showed H1N1 infection. The patients are young adults without any additional desease and after recovery they were discharged from hospital. They are folowed up for 3 years and two common deteails are found: they don’t eat meat and both of them has a minor clotting deficiency. Conclusion: Initial therapy of oseltamivir, pulse streroid therapy, vancomycin, levofloxacin and NİV support results as suitable therapy for H1N1 induced ALI-ARDS. ECMO support is vital therapy in severe cases in which initial correct therapy is delayed. Suspition of viral infections and timing of current therapy in H1N1 induced ALI-ARDS is a challenge for clinicians. We recomend early therapy of oseltamivir in such cases. The new predisposing factors for H1N1 desease may be some clotting disturbancies and not eating meat. Keywords: H1N1, oseltamavir, pulse streroid, predisposing factors, Acute Respiratory Distress Syndrome