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Non-invasive ventilation (NIV) is considered first-line intervention for different causes of acute respiratory failure [1]. However, Rello and colleagues [2] show high rates of NIV failure in pandemic Influenza A/H1N1 virus infection (PH1N1).  We describe a patient with PH1N1 in whom NIV was effective. A 53-year-old male was admitted in November 2009 with cough, dyspnea, and hemoptysis. His temperature was 38.9°C, he was tachypneic, with diffuse rhonchi and bilateral crackles, and oxygen saturation was 96% (4 L/min oxygen). Arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were 76 and 23 mm Hg, respectively. Creatine kinase (2,278 U/L) and brain natriuretic peptide (3,544 pg/mL) were increased. Acute myocardial infarction was excluded. Chest x-ray showed bilateral interstitial infiltrates and cardiomegaly. Echocardiogram showed severe left ventricular systolic dysfunction. PH1N1 pneumonia was suspected, and oseltamivir was administered in association with antibiotics and diuretics. On day 2, a nasopharyngeal swab was positive for PH1N1. The patient was subsequently transferred to a negative-pressure ward. He was still tachypneic, with basal crackles and a PaO2/fraction of inspired oxygen (FiO2) ratio of 246. NIV (BiPAP Vision; Philips Respironics, Murrysville, PA, USA) through an oro-nasal mask inbilevel positive airway pressure mode (inspiratory positive airway pressure [IPAP] = 16 cm H2O, expiratory positive airway pressure [EPAP] = 8 cm H2O) was started. Due to patient preference, the mode was changed to continuous positive airway pressure (CPAP) at 10 cm H2O and an FiO2 of 25%. After 1 hour, PaO2/FiO2 increased to 364, and CPAP was stopped after 12 hours.  Recently, Djibre and colleagues [3] demonstrated the effectiveness of NIV in acute respiratory distress syndrome related to PH1N1 pneumonia. Our case further supports its role in a hypoxemic patient with cardiogenic pulmonary edema and PH1N1 pneumonitis.

Non-invasive ventilation in acute respiratory failure related to 2009 pandemic Influenza A/H1N1 virus infection