H1N1 influenza-associated pneumonia with severe obesity: successful management with awake veno-venous extracorporeal membrane oxygenation and early respiratory physical therapy

Abstract

Case: We report a case of H1N1 influenza-associated respiratory failure with severe obesity.

Outcome: A 54-year-old man was admitted to our intensive care unit (ICU) because of H1N1 influenza-associated severe respiratory failure. He was severely obese, having a body mass index of 37.2. His respiratory condition remained severe under mechanical ventilation. We started veno-venous extracorporeal membrane oxygenation immediately. Awake management was started on ICU Day 6, and the patient's respiratory physical therapy began the following day. His respiratory condition showed excellent improvement immediately following the initiation of respiratory physical therapy. The patient was successfully decannulated on ICU Day 9, and he was discharged from the ICU on Day 11. He was discharged from the hospital with no severe disability on disease Day 60.

Conclusion: Awake extracorporeal membrane oxygenation management with early respiratory physical therapy can be useful in the treatment of morbidly obese patients who present with severe respiratory failure.

Keywords: Extracorporeal membrane oxygenation; H1N1 influenza; obesity; respiration; respiratory physical therapy.

Figure 1

Chest X‐ray and computed tomography scans of a 54‐year‐old man with H1N1 influenza‐associated pneumonia on the first day of admission to the intensive care unit. These images show bilateral consolidation and atelectasis.

Figure 2

Clinical course of a 54‐year‐old man with H1N1 influenza‐associated pneumonia after admission to the intensive care unit (ICU) (left) and the respiratory physical therapy setup (right). The patient's PaO ₂/F_IO ₂ (P/F) ratio showed excellent improvement immediately following respiratory physical therapy initiation. VV‐ECMO, veno‐venous extracorporeal membrane oxygenation.

Figure 3

Chest X‐ray and computed tomography scans of a 54‐year‐old man with H1N1 influenza‐associated pneumonia after decannulation. These images show improvements in bilateral consolidation and atelectasis.