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Influenza and the Critically Ill
- It is that time of year again to be vigilant for cases of influenza
- Influenza is not benign and causes > 40,000 deaths per year and is the 7th leading cause of death in the US
- In the critically ill, the most severe disease occurs in patients > 65 and those with underlying cardiopulmonary disease
- Critically ill patients with influenza can present with fever, cough, bilateral interstitial infiltrates, hypoxemia, and leukopenia
- Other serious complications include myocarditis, encephalitis, and Reye syndrome
- Amantadine and rimantadine should no longer be used, as the resistance has risen to > 90% in some populations
- Oseltamivir (PO) and zanamivir (powder/inhalation) are the approved neuraminidase inhibitors; both decrease the severity and duration of illness; should be given as early as possible, preferably within 36 hours
References
Beigel JH. Influenza. Crit Care Med 2008;36:2660-6.