CUTE LUNG INJURY AND ACUTE respiratory distress syndrome (ARDS, the most severe form of acute lung injury), are potentially devastating complications of critical illness. 1 Arising in response to direct lung injury (eg, pneumonia) or intense systemic inflammation (eg, sepsis), 2 the pathogenesis involves pulmonary edema, diffuse cellular destruction, alveolar collapse, and disordered repair. Mortality and health care costs are high, 3 and long-term survivors experience serious morbidity. 4 See also pp 646, 691, and 693.

In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes. (Funded by the National Health and Medical Research Council of Australia and others; DECRA Australian Clinical Trials Registry number, ACTRN012605000009617.).

Patient characteristics and ventilation practices have changed over time, and outcomes of mechanically ventilated patients have improved. Clinical trials registered with www.clinicaltrials.gov (NCT01093482).

Context The novel influenza A(H1N1) pandemic affected Australia and New Zealand during the 2009 southern hemisphere winter. It caused an epidemic of critical illness and some patients developed severe acute respiratory distress syndrome (ARDS) and were treated with extracorporeal membrane oxygenation (ECMO). Objectives To describe the characteristics of all patients with 2009 influenza A(H1N1)associated ARDS treated with ECMO and to report incidence, resource utilization, and patient outcomes. Design, Setting, and Patients An observational study of all patients (n=68) with 2009 influenza A(H1N1)-associated ARDS treated with ECMO in 15 intensive care units (ICUs) in Australia and New Zealand between June 1 and August 31, 2009. Main Outcome Measures Incidence, clinical features, degree of pulmonary dysfunction, technical characteristics, duration of ECMO, complications, and survival.