To assess the comparative efficacy of respiratory protective devices for the prevention of influenza among health care workers, Loeb and colleagues Article randomly assigned nurses at 8 tertiary care hospitals to wear either a surgical mask or an N95 respirator mask when caring for patients with a febrile respiratory illness during the 2008-2009 influenza season. The authors report that the incidence of laboratory-confirmed influenza was similar in both groups, with surgical masks appearing to be noninferior to N95 respirators in preventing influenza. In an editorial, Srinivasan and Perl Article discuss respiratory protection and the prevention of influenza transmission in health care settings.
Characteristics, treatment, and outcomes of critically ill patients with 2009 influenza A(H1N1) infection in Canada and Mexico are reported in 2 articles in this issue—the first by Kumar and colleagues Article from the Canadian Critical Care Trials Group H1N1 Collaborative and the second by Domínguez-Cherit and colleagues Article who report on patients from Mexico. Among the findings from the 2 investigations are that patients tended to be young and relatively healthy, yet critical illness occurred rapidly after hospital admission, characterized by severe respiratory distress, prolonged mechanical ventilation, and frequent use of rescue therapies. In an editorial, White and Angus Article discuss the critical care response to pandemic H1N1 influenza.
During the 2009 influenza A(H1N1) outbreak, the Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators collected data on the incidence, clinical features, complications, and survival of patients with severe influenza-associated acute respiratory distress syndrome (ARDS) treated with ECMO. Davies and colleagues Article report that among 201 patients treated with mechanical ventilation at centers with ECMO capability, 68 patients received ECMO. Patients' median age was 34.4 years, severe respiratory failure ensued despite advanced mechanical ventilatory support, the median duration of ECMO support was 10 days, and mortality was 21%. In an editorial, White and Angus Article discuss the use of ECMO to decrease H1N1-associated mortality.
Louie and colleagues from the California Pandemic (H1N1) Working Group reviewed public health surveillance data and medical records from 1088 California residents who were hospitalized or died with laboratory evidence of pandemic 2009 influenza A(H1N1) infection through August 11, 2009. Among the authors' findings are that the median age of hospitalized patients was 27 years (range, <1-92 years) and 68% had risk factors for seasonal influenza complications. Thirty-one percent of patients required intensive care, and the overall mortality was 11%. Rapid-antigen tests were falsely negative in 34% of cases evaluated.
“Pulling the curtains aside is an intensely personal moment, one that implies permission to probe the most intimate details of patients' lives.” From “Curtains.”
US public health authorities offer updated guidance on strategies to protect clinical workers from 2009 influenza A(H1N1) infection, taking into account emerging data about use of surgical masks and respirators.
Rhabdomyolosis associated with influenza A(H1N1)
Gerberding discusses the challenges posed by the 2009 influenza A(H1N1) virus.
Join Michael S. Krasner, MD, November 18, 2009, from 2 to 3 PM eastern time to discuss the association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you care for a 66-year-old man with an abdominal aortic aneurysm? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is November 8.
For your patients: Information about influenza.
This Week in JAMA . JAMA. 2009;302(17):1839. doi:10.1001/jama.2009.1613