Pandemic influenza A(H1N1) 2009 – the experience and pressure on Intensive Care Units (ICU’s) - implications for specialists in critical careArchived

ECDC comment

The journal Critical Care Medicine has recently published a supplement of open access articles on the experience in intensive care units during the 2009 pandemic of influenza.

The journal Critical Care Medicine has recently published a supplement of open access articles on the experience in intensive care units during the 2009 pandemic of influenza.Though mostly describing the North American experience there is no reason for European professionals not to draw on these articles. Two of many are:

Complications of seasonal and pandemic influenza Rothberg MB and Haessler SDCritical Care Medicine 38(): e91-e97, This is a general review encompassing complications and severe presentations of both seasonal and 2009 pandemic influenza. The researchers document how, in contrast to seasonal influenza, severe disease caused by pandemic influenza A(H1N1) 2009 in the pandemic was concentrated in older children and young adults, with few cases reported in patients older than 60 years of age. In addition, this study shows that although patients with underlying cardiopulmonary disease remained at risk with obesity and respiratory disease as the strongest risk factors many complications occurred among previously healthy individuals.  Although pulmonary complications were common respiratory findings, the authors suggest that primary influenza pneumonia occurred most commonly in adults and progressed rapidly to acute lung injury requiring mechanical ventilation. In the bacteriology arena, secondary bacterial infection was more commonly observed in children, with Staphylococcus aureus, including methicillin-resistant strains, being an important cause of secondary bacterial pneumonia with a high mortality rate, however,. during the 2009 pneumococcal pneumonia and other streptococcal infections were also important. The authors add that although neuromuscular and cardiac complications are unusual these may occur.

Practical lessons from the first outbreaks: Clinical presentation, obstacles, and management strategies for severe pandemic (pH1N1) 2009 influenza pneumonitis Funk D J, Siddiqui F, Wiebe K, et al.Critical Care Medicine 38(): e30-e37, This article is an easy to understand narrative description of the different problems experienced by health care workers in North American cities during the spring wave of the 2009 influenza A(H1N1) pandemic. It mainly focuses on findings observed in the city of Winnipeg – the capital of the province of Manitoba in central Canada – and in some US cities – notably Salt Lake City (state of Utah) and Orlando (state of Florida) – as well as in Mexico city.  Winnipeg was one of the first urban centres in North America to deal with a quick upsurge in the number of patients requiring critical care services resulting from infection with the pandemic virus and presenting with influenza-associated respiratory failure. The main aim of this paper was to pin-point a varied range of issues and difficulties which caused significant stress to the operations of ICU’s in these cities with the hope that the lessons learned might help to prevent future pressures in similar circumstances. In addition the authors draft potential solutions for some of the constraints described here.

Other articles related to the topic ‘pressures on the ICU’s’ from the supplement of Critical Care Medicine:

ECDC Comment (4th March 2011):

The experience of the 2010-2011 winter has made this supplement particularly important for Europe. In a number of EU countries the experience of the winter season that is now coming to an end has been that the pressures on the intensive care units were comparable to or greater than those during the pandemic. (1,2) The reason for this is not clear but the effect was similar with a degree of disruption following from high intensive care bed occupancy in some EU countries. Population peak demands have been up to a range of 1.0 to 1.4 cases of influenza needing an intensive care bed per 100,000 population at peak times.  The disruption has come for countries with limited higher level care capacity since a number of larger surgical procedures (emergency and non-emergency) require post operative care in an intensive care bed. Services have coped but they have had in some localities to enact reserve plans, bringing into action some reserve capacity and in other places cancelling non-urgent major surgery.  What remains unclear at present is the reason for the heterogeneity of this picture. Why the population rates were so much higher in some EU countries than others  Simple analysis does not reveal an answer. 


  1. ECDC Interim Risk Assessment   Seasonal influenza 2010–2011 in Europe (EU/EEA countries)  January 2011