– H1N1pdm09 pandemic (2009), young and middle-aged low flu vaccine coverage

– sudden fever, cough, rhinorrhea, myalgia –> deteriorate in 4-5d –> hypoxemia, shock, multiorgan dysfunction

Dx:  consider ET aspirate and BAL fluid RT-PCR for patients with RF without etiology (rapid flu tests and IF assays can produce false-negative results)

Tx:  Oseltamivir – empirically ASAP, if contraindicated or resistant, use IV neuramidase inhibitor (zanamivir); empiric broad-spectrum ABx to cover staph (+MRSA), strep PNA, strep pyogenes; consider high dose vasopressors, CRRT, systemic anticoagulation

– early transfer to regional center (ECMO, prone positioning, NM blockade, inhaled NO, lung recruitment maneuvers)

– avoid corticosteroids (higher mortality)

*Lena M. Napolitano et al  JAMA. 2014;311(13):1289-1290. doi:10.1001/jama.2014.2116.