Influenza and the Critically Ill

• It is that time of year again to be vigilant for cases of influenza
• Influenza is not benign and causes > 40,000 deaths per year and is the 7th leading cause of death in the US
• In the critically ill, the most severe disease occurs in patients > 65 and those with underlying cardiopulmonary disease
• Critically ill patients with influenza can present with fever, cough, bilateral interstitial infiltrates, hypoxemia, and leukopenia
• Other serious complications include myocarditis, encephalitis, and Reye syndrome
• Amantadine and rimantadine should no longer be used, as the resistance has risen to > 90% in some populations
• Oseltamivir (PO) and zanamivir (powder/inhalation) are the approved neuraminidase inhibitors; both decrease the severity and duration of illness; should be given as early as possible, preferably within 36 hours

 

 

 

 

 

 

 

 

References

 Beigel JH. Influenza. Crit Care Med 2008;36:2660-6.