The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during epidemics of seasonal influenza, in that many of those affected were previously healthy young people. Current predictions estimate that, during a pandemic wave, 12-30% of the population will develop clinical influenza (compared with 5-15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. This review covers the background, clinical presentation, diagnosis, and treatment. The role of immunization and antiviral drugs is discussed. Experience from the first wave of pandemic (H1N1) 2009 influenza suggests that a number of infected patients become critically ill and require intensive care admission. These patients rapidly develop severe progressive respiratory failure which is often associated with failure of other organs, or marked worsening of underlying airways disease. The critical care management of these patients and the implications for resources is reviewed. Guidance from a range of bodies has been produced in a relatively short period of time in response to pandemic (H1N1) 2009 influenza. Disease severity has the potential to change, especially if there is virus mutation. Clinicians must be prepared for the unexpected and continue to share their experiences to maximize patient outcomes.

SummaryThis case series details experience of critical care admissions with pandemic (H1N1) 2009 influenza from an intensive care unit in the West Midlands. We present four critically ill patients admitted with severe hypoxia. Two of the patients failed a trial of continuous positive airway pressure and all underwent controlled ventilation within 24 h of admission. Bilevel and high frequency oscillatory ventilation were the most useful modes. Our patients generally had one organ failure and were ventilator dependent for relatively short periods of time. Three of the patients made a full recovery and one required ongoing dialysis. We also discuss service planning and our response to the pandemic. We were well prepared with stocks of personal protective equipment but had to modify plans as the outbreak progressed. Our cases and discussion provide useful information for other intensive care units preparing for the predicted autumn surge of H1N1 cases.

The aim of this article is to outline the problems and solutions in pain management experienced during the transfer of patients. Although focusing on strategic aeromedical transfers many of the concepts will be of value regardless of the mode of transport.