Noninvasive mechanical ventilation in patients with acute respiratory failure due to H1N1 infection

We evaluated the clinical outcomes of consecutive patients positive for H1N1 and admitted to 6 Intensive Care Units in Italy for severe Acute Respiratory Failure and requiring non-invasive mechanical ventilation (NIV). 29/54 (54%) patients admitted to the ICUs needed immediate intubation for gasping, coma or respiratory arrest. The remaining 25 patients (mean age 49.8±12) underwent an NIV trial as a first line treatment using the helmet (n.19 patients) or a total face mask (n.6). Arterial Blood Gases (ABGs) at enrolment were: pH=7,41±0.02, PaO 2 /FiO 2 =117±64 and PaCO 2 =40,5±9. At the first ABGs control (between 309 and 909) PaO 2 /FiO 2 significantly (p 2 to 36.4±9. Mean duration of NIV was 49.8±33 hrs. 10/25 (40%) of the patients required intubation after 20.3 hrs. Overall mortality rate was 7/25 (28%), with all the deaths occurring in the NIV failure group. NIV failure had a lower PaO 2 /FiO 2 at admission (78.6±21 vs 152.4±32 p