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Swine Flu - Severe Or Mild Little In-Between

Posted by Jane Akre
Monday, October 12, 2009 10:48 PM EST
Category: Major Medical
Tags: Swine Flu, Seasonal Flu, Tamiflu, H1N1, ICU, CDC, JAMA, NEJM

Swine flu cases, when they are severe, usually end the patient in ICU.

Published Studies Look At Extreme Cases

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IMAGE SOURCE: ©iStockphoto/ intensive care

Doctors say it’s almost like two different diseases – swine flu that is mild or swine flu that makes people critically ill requiring aggressive intensive care unit (ICU) care.

“There isn’t much of a middle ground” says Anand Kumar, lead author of one of three new studies on the disease. His is published in the Journal of the American Medical Association (JAMA).

Dr. Kumar, of Winnipeg, Canada, looked at critically ill patients in Canada, Mexico, Australia, and New Zealand. Some were so ill they require sophisticated equipment and treatment similar to what’s used to save patients undergoing heart bypass.

The fear is that existing intensive-care units might not be adequate to accommodate a second wave of H1N1 that could number 300,000 patients and take up half of all ICU beds.

In all three studies, patients entering the hospital progressed to respiratory failure, shock, and organ dysfunction requiring ventilators and life saving therapies such as “Extracorporeal membrane oxygenation” or ECMO.  In that therapy, the patient’s blood is circulated through a system that adds oxygen so they can get oxygen to their blood that their fluid-filled lungs can't deliver.

In Australia and New Zealand, 54 of 68 patients treated with ECMO survived and 14 died. The median age for treatment was 34 years. Dr. Kumar’s study saw an average age of swine flu patient at 32 years.

Among those patient, most had an aggressive form of viral pneumonia and the majority suffered from other health conditions with a third suffering from pre-existing problems such as heart failure or immune suppression, according to the Wall Street Journal.

Others had health conditions such as diabetes, were smokers or pregnant.

As for severe cases of the flu, in the Canadian study about 3.9 percent had been admitted to ICUs.

In the U.S., one quarter of sick Americans who needed hospitalization wound up in intensive care. Among those patients, seven percent died.

That study by researchers at the Centers for Disease Control and Prevention (CDC) was published last week in the New England Journal of Medicine.

It finds half of the hospitalized cases were children and teens and only five percent were age 65 and older, seven percent were pregnant, even though pregnant women make up one percent of the general population. About one in four were very obese. Those numbers are slightly higher than seasonal flu.

The CDC concludes that use of antiviral medicines such as Tamiflu, were crucial when given early to help patients survive. #


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