Severe flu management: a point of view

• Published in: Intensive care medicine 2020-02, Vol.46 (2), p.153-162
• Main Authors: Torres, Antoni, Loeches, Ignacio-Martin, Sligl, Wendy, Lee, Nelson
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anesthesiology; Antibacterial agents; Antifungal agents; Antiinfectives and antibacterials; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Canada; Care and treatment; Corticoids; Corticosteroids; Critical Care Medicine; Critical Illness - epidemiology; Critical Illness - therapy; Development and progression; Diagnosis; Diagnostic systems; Diagnostic tests; Emergency Medicine; Evidence-based medicine; Extracorporeal Membrane Oxygenation - methods; Fungicides; Health aspects; Humans; Infections; Influenza; Influenza, Human - diagnosis; Influenza, Human - genetics; Influenza, Human - physiopathology; Intensive; Intensive care; Intensive Care Units - organization & administration; Lee, Nelson; Medical diagnosis; Medicine; Medicine & Public Health; Morbidity; Mortality; Narrative Review; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Prevention; Seasons; Severe infections in the critically ill; Therapy; United Kingdom
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-019-05868-8

Annual flu seasons are typically characterized by changes in types and subtypes of influenza, with variations in terms of severity. Despite remarkable improvements in the prevention and management of patients with suspected or laboratory-confirmed diagnosis of influenza, annual seasonal influenza continues to be associated with a high morbidity and mortality. Admission to the intensive care unit is required for patients with severe forms of seasonal influenza infection, with primary pneumonia being present in most of the cases. This review summarizes the most recent knowledge on the diagnosis and treatment strategies in critically ill patients with influenza, focused on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, and supportive measures. The review focuses on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, supportive measures and relevant existing evidence, in order to provide the non-expert clinician a useful overview. An enhanced understanding of current diagnostic and treatment aspects of influenza infection can contribute to improve outcomes and reduce mortality among ICU patients with influenza.