Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 20 , ISSUE 1 ( 2016 ) > List of Articles


Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome

Dnyaneshwar P. Mutkule, Kartik Munta, Pradeep M. Venkategowda, Mallela V. Rao, Yogesh R. Harde, Mithilesh K. Raut

Keywords : Influenza A virus, inverse ratio ventilation, pressure control ventilation, prone position, severe acute respiratory distress syndrome

Citation Information : Mutkule DP, Munta K, Venkategowda PM, Rao MV, Harde YR, Raut MK. Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome. Indian J Crit Care Med 2016; 20 (1):44-49.

DOI: 10.4103/0972-5229.173690

License: CC BY-ND 3.0

Published Online: 01-06-2013

Copyright Statement:  Copyright © 2016; The Author(s).


Aim: To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV). Materials and Methods: All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO 2 of 0.6 or less and positive end-expiratory pressure <10 cm of H 2O. Results: At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6-8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO 2 /FiO 2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days. Conclusion: Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.

PDF Share
  1. Centers for Disease Control and Prevention (CDC). Swine influenza A (H1N1) infection in two children - Southern California, March-April 2009. MMWR Morb Mortal Wkly Rep 2009;58:400-2.
  2. Ministry of Health and Family Welfare, Government of India. Pandemic Influenza A (H1N1) Situational Update; 2009. Available from: Updates Archives/may/Situational%20Updates%20on%2016.05.2009.pdf. [Last accessed on 2011 Oct 12].
  3. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.
  4. World Health Organization. CDC Protocol of Realtime RTPCR for Influenza A (H1N1). Available from: [Last updated on 2009 Oct 06; Last cited on 2009 Nov 21].
  5. Roy GB, Michael AM, Alan M, David S, Tylor TB, Arthur W. Ventilation with low tidal volumes as compared to traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342:1301-8.
  6. Richter T, Bellani G, Scott Harris R, Vidal Melo MF, Winkler T, Venegas JG, et al. Effect of prone position on regional shunt, aeration, and perfusion in experimental acute lung injury. Am J Respir Crit Care Med 2005;172:480-7.
  7. Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, et al. Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001;345:568-73.
  8. Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, et al. Decrease in PaCO with prone position is predictive of improved outcome in acute respiratory distress syndrome. Crit Care Med 2003;31:2727-33.
  9. Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: A randomized controlled trial. JAMA 2009;302:1977-84.
  10. Sud S, Sud M, Friedrich JO, Adhikari NK. Effect of mechanical ventilation in the prone position on clinical outcomes in patients with acute hypoxemic respiratory failure: A systematic review and meta-analysis. CMAJ 2008;178:1153-61.
  11. Cesana BM, Antonelli P, Chiumello D, Gattinoni L. Positive end-expiratory pressure, prone positioning, and activated protein C: A critical review of meta-analyses. Minerva Anestesiol 2010;76:929-36.
  12. Kim SH, Hong SB, Yun SC, Choi WI, Ahn JJ, Lee YJ, et al. Corticosteroid treatment in critically ill patients with pandemic influenza A/H1N1 2009 infection: Analytic strategy using propensity scores. Am J Respir Crit Care Med 2011;183:1207-14.
  13. Brun-Buisson C, Richard JC, Mercat A, Thiébaut AC, Brochard L; REVA-SRLF A/HNv Registry Group. Early corticosteroids in severe influenza A/H1N1 pneumonia and acute respiratory distress syndrome. Am J Respir Crit Care Med 2011;183:1200-6.
  14. Quispe-Laime AM, Bracco JD, Barberio PA, Campagne CG, Rolfo VE, Umberger R, et al. H1N1 influenza A virus-associated acute lung injury: Response to combination oseltamivir and prolonged corticosteroid treatment. Intensive Care Med 2010;36:33-41.
  15. Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter-Widmer I, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: A multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2015;385:1511-8.
  16. ANZIC Influenza Investigators, Webb SA, Pettilä V, Seppelt I, Bellomo R, Bailey M, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009;361:1925-34.
  17. Sahoo JN, Poddar B, Azim A, Singh RK, Gurjar M, Baronia AK. Pandemic (H1N1) 2009 influenza: Experience from a critical care unit in India. Indian J Crit Care Med 2010;14:156-9.
  18. Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (HN) Influenza, Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, et al. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med 2010;362:1708-19.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.