A 25-year-old man with a history of mild intermittent asthma is admitted to the ICU with rapidly progressive hypoxemic respiratory failure following 4 days of fevers, myalgias, and cough at home. He is intubated and mechanically ventilated on volume assist-control with a tidal volume of 6 mL/kg, respiratory rate 14 breaths per minute, FiO2 0.8, and PEEP of 10 cm H2O. His arterial blood gas on these settings is:
His chest radiograph demonstrates diffuse bilateral patchy opacities, and his rapid influenza testing is positive for influenza A.
Which of the following statements is MOST accurate regarding diagnosis and treatment for this patient?A. With his history of asthma, he should receive methylprednisolone at 1 mg/kg daily
Correct Answer: D
This patient is presenting with respiratory failure secondary to influenza A infection. He meets clinical criteria for ARDS, which include acute onset of bilateral infiltrates with associated hypoxemia in the absence of evidence of explanatory cardiogenic pulmonary edema (answer E is incorrect). Mainstays of treatment for severe influenza pneumonia include antiviral therapy with oseltamivir (answer C is incorrect) and empiric treatment of possible secondary bacterial infection (answer B is incorrect). Common bacterial pathogens that coinfect with influenza include S. pneumoniae, Staphylococcus aureus, and Haemophilus influenzae, and coverage should be targeted to these organisms. Treatment with steroids in patients with influenza infection is associated with an increased risk of mortality, and although these data are observational, the consensus is that steroids should be avoided if possible (answer A is incorrect).