H1n1 drugs. What is swine flu or A(H1N1) virus and how to deal with it? Lung Injuries - Dangerous Complications of H1N1 Influenza

Swine flu is an acute, contagious infectious disease caused by influenza A (H1N1) virus. The virus differs from the common flu virus in that people are more susceptible to it. Due to this, the swine flu virus leads to a rapid increase in the number of sick people, there may be a pandemic.

Swine flu is characterized in most cases by a severe course and there is a risk of fatal outcomes of the disease.

A sick person is contagious already 24 hours before the first manifestations of the disease, the contagiousness persists for 7-10 days from the onset of the disease.

Infection occurs in two ways:

• airborne - the release of viral particles when coughing and sneezing;
• contact-household - infection occurs through household items, the virus enters the body of a healthy person through the hands.

Important! The virus remains on household surfaces for about two hours.

Most susceptible to the swine flu virus:

• persons over 65 years of age;
• children under the age of 5;
• persons with severe concomitant chronic pathology ( diabetes, heart disease, lung disease, obesity);
• pregnant women.

The following groups are at high risk of infection:

• representatives of professions related to direct communication with people (salespeople, teachers);
• healthcare workers are particularly susceptible.

Why influenza A (H1 N1) called pig

When a new strain of influenza was isolated in 2009, scientists recklessly compared it to a virus found in North American pigs. When it later turned out that the origin of the H1N1 virus is much more complicated, the name has already come into use.

swine flu symptoms

Incubation period(the period from infection to manifestation of the disease) with swine flu is usually no more than 72 hours.

The first signs of the disease are similar to those of the common flu. Swine flu begins with an intoxication syndrome, which includes the following symptoms:

• body temperature rises sharply from 38.0 to 40-41 degrees;
• severe general weakness;
• aches in muscles and joints;
• Strong headache;
• lethargy, fatigue.

A third of patients develop a characteristic dyspeptic syndrome:

• frequent vomiting;
• persistent nausea;
• diarrhea.

Later, symptoms characteristic of a lesion of the respiratory tract appear:

• dryness and sore throat;
• dry cough;
• dyspnea;
• chest pain when coughing.

Complications of influenza A (H1N1)

The most common complication of swine flu is pneumonia (inflammation of the lungs).

Pneumonia can be primary (from exposure to the H1N1 virus) and secondary (with the addition of bacterial inflammation).

On the second or third day, viral pneumonia or hemorrhagic disorders (nosebleeds, bruising on the mucous membranes and skin) may develop.

Viral pneumonia is characterized by the following symptoms:

• appearance on 2-3 days;
• shortness of breath (respiratory rate increases);
• strong dry cough;
• blue distal parts of the extremities (acrocyanosis) and cyanosis of the nasolabial triangle;
• moist rales on auscultation.

The manifestations of secondary (bacterial) pneumonia are somewhat different from the manifestations of viral pneumonia:

• bacterial pneumonia appear on the 7-10th day of the disease;
• they are characterized by a gradual increase in cough;
• after some improvement in the general condition, deterioration develops again;
• second wave of temperature increase;
• cough with greenish sputum;
• darkening of the lung fields on the radiograph.

The following complications are less common:

• Hemorrhagic syndrome - nosebleeds, bruising in the skin and mucous membranes;
• Infectious-allergic myocarditis (damage to the heart muscle).

To diagnose swine flu, swabs are taken from the mucous membranes of the pharynx and nose (isolation of the RNA virus).

The presence of antibodies in the blood is also determined using serological diagnostic methods.

Treatment

When the first signs of swine flu appear, you should immediately consult a doctor (call a doctor at home). To prevent infection of loved ones, wear a disposable mask.

Mild forms of swine flu can be treated on an outpatient basis.

Hospitalizations are subject to:

• children;
• persons over 65 years of age;
• individuals with severe comorbidities;
• moderate and severe forms of swine flu;
• pregnant.

Important! If symptoms of viral or bacterial pneumonia occur, it is necessary to call a therapist at home, however, with a sharp and rapid deterioration in the condition, it is recommended to immediately call emergency care.

In the treatment of swine flu, it is mandatory to prescribe antiviral drugs. Currently, only the following drugs have antiviral activity against the swine flu virus:

• Oseltamivir (Tamiflu);
• Zanamivir (Relenza).

The rest of the drugs do not have proven antiviral properties in relation to the swine flu virus.

To remove the intoxication syndrome, detoxification therapy is carried out (in a hospital setting).

At treatment of mild forms at home, it is imperative to observe an abundant drinking regime (water, berry fruit drinks, tea with lemon).

Symptomatic therapy is also used:

• cough treatment (ACC, Ambrohexal, Fluditec);
• removal of temperature (Paracetamol, Ibuprofen; Ibuklin);
• vasoconstrictor nasal drops (Rinonorm, Vibracil, Otrivin).

The duration of the course of mild forms of swine flu is from 7 to 10 days. Severe forms can last up to 3-4 weeks.

Treatment of complications (pneumonia)

Treatment of pneumonia with swine flu is carried out strictly in a hospital.

Viral pneumonia is treated with antiviral drugs, and bacterial pneumonia is treated with antibiotics.

Antibiotics are prescribed taking into account the sputum culture (it is determined what exactly the bacteria are sensitive to).

Before the results of bakposev, treatment is started with macrolide antibiotics (erythromycin, azithromycin), cephalosparins (ceftriaxone), rarely respiratory fluoroquinolones (Tavanic) - with the ineffectiveness of the first two.

Sometimes 2 groups are connected at once, then penicillins can be added (for severe pneumonia).

Treatment of pneumonia lasts from 14 days to 1 month.

Prevention of swine flu

Swine flu is easier to prevent than to fight.

For this, there are specific and non-specific methods of prevention.

Non-specific recommendations include the following:

• Do not visit places with large crowds of people during periods of epidemics.
• Frequent hand washing with soap and water antiseptics when they cannot be washed.
• Avoid contact with sick people.
• Avoid shaking hands and kissing during epidemics.
• Treatment of the nasal mucosa with Viferon gel before leaving the house and upon arrival home (used as a non-specific prophylaxis, for local immunostimulating action).

Important! Antiviral drugs do not completely protect against infection.

swine flu vaccine

If a person has had contact with a sick swine flu, then antiviral drugs (Tamiflu or Relenza) can be used as a prophylaxis in a standard dosage in accordance with the instructions.

Specific prevention is vaccination.

Vaccination should be carried out at least 1 month before the expected date of the epidemic. Usually vaccinated in October-November.

After vaccination, immunity to the swine flu virus is formed, due to which a person either does not get sick at all, or will get sick in a mild form without complications.

It all depends on the intensity of the developed immunity - if the immunity is not strong enough, then the disease may begin as a result, but in a milder form. This fact is the source of controversy about the effectiveness of the swine flu vaccination. We emphasize once again that vaccination does not provide 100% protection against swine flu, but it reduces the severity of the disease. The effectiveness of vaccination depends on the immunity of a particular person.

Vaccination should be done annually.

The so-called swine flu is a type of influenza caused by a reassortant virus (in the English literature, the causative agent is referred to as Swine-Origin Influenza A(H1N1) Viruses).

Swine flu type A was described in 1931. Its local outbursts arose repeatedly. The last epidemic began in Mexico in March 2009, spread to the United States, South America, and then to other continents and countries, including Russia, and assumed the scale of a pandemic. In 2010, WHO announced the end of the pandemic.

As of 2016, the H1N1 virus continues to circulate as one of the seasonal flu strains. On the one hand, the H1N1 virus is expected to continue to circulate as a seasonal influenza strain for the foreseeable future and, as a result, more people will develop immunity to the virus. On the other hand, the virus is also expected to change over time as a result of antigenic drift, and such changes may mean that the protective power of immunity that has developed against this strain of the virus may be weakened in relation to future varieties of this virus. In addition, many people were not infected with the H1N1 virus during the pandemic and therefore, in some countries, there may be areas where the impact of the pandemic was less severe and where it may be more severe later.

Based on the available evidence, the H1N1 virus currently continues to pose an increased risk of severe illness for the same groups, including young children, pregnant women, and people with respiratory and chronic health conditions. It is likely that we will still see cases of severe illness in both high-risk and otherwise healthy people.

Causes of swine flu

Swine influenza virus is a triple reassortant of human, avian and swine influenza viruses. All influenza viruses belong to the group of pneumotropic RNA viruses belonging to the Orthomyxoviridae family. Their virions have a round or oval shape with a particle diameter of 80–100 nm. The core of the virion (nucleocapsid) consists of a helical strand of ribonucleoprotein, topped with a lipoglycoprotein membrane. The composition of the outer layer of the virion envelope includes glycoproteins with hemagglutinating and neuraminidase activity. The virus contains the enzyme RNA polymerase. According to the antigenic characteristics of the internal nucleoprotein (S-antigen), influenza viruses are divided into types A, B and C. Type A influenza viruses, depending on the antigenic properties of the glycoproteins of the outer shell - hemagglutinin (H) and neuroamidase (N) - are divided into subtypes (H1– 3, N1–2). The standard designation of influenza A virus strains includes: virus type, host species (other than human), site of isolation, strain number, year of isolation, and hemagglutinin and neuraminidase formula, such as A/California/07/2009(H1N1).

In contrast to viruses B and C, which are characterized by a more stable antigenic structure, influenza A viruses have significant variability in surface antigens. It manifests itself either as an antigenic "drift" (partial renewal of antigenic determinants) of hemagglutinin or neuraminidase within one subtype, or as an antigenic "shift" (complete replacement of a genome fragment encoding hemagglutinin or hemagglutinin and neuraminidase), which leads to the emergence of new subtypes. among type A viruses.

The influenza pandemic of 2009, known as "swine flu", was caused by the A/H1N1/09 ​​virus, which has the greatest genetic similarity to the swine flu virus.

"Swine flu" is a combination of the genetic material of already known strains - influenza of pigs, birds and humans. The origin of the strain is not exactly known, and the epidemic distribution of this virus among pigs could not be established. Viruses of this strain are transmitted from person to person and cause diseases with symptoms common for influenza.

The disease is transmitted by airborne droplets.

Susceptibility has an age character. Mostly people under 30 years of age are ill. The overall morbidity rate is less than with "seasonal" influenza, however, since only severe inpatients are examined, registration is incomplete.

The pathogenesis of swine flu

The pathogenetic feature of swine flu is the ability of the new virus to cause a sharp activation of inflammatory mediators, which in severe cases leads to damage to the alveolar epithelium, the development of ARDS and pneumonia.

Like any disease infectious nature, influenza is the result of bilateral interaction of micro- and macroorganism. The high ability to change the genome of viruses has led to the emergence of their new subtypes, which have a much greater ability than classical respiratory viruses to generate an uncoordinated inflammatory response of the macroorganism. As in the case of complicated infections of a bacterial nature, in influenza A / H1N1 / 09, the main driving force behind the systemic disorders that occur in the body is the systemic inflammatory response syndrome. It has been shown that in this case, in addition to IL-6, IL-8, IFN-γ, TNF, a number of others act as key inflammatory mediators - IL-9, IL-15, IL-17, IL-12p70 secreted by activated leukocytes.

Important features of the course of the pandemic variant of influenza are more frequent and pronounced lesions of the lower respiratory tract, the ability to develop and rapidly progress of acute respiratory failure due to viral pneumonia with the development of acute respiratory distress syndrome (ARDS), and in some cases, shock, renal dysfunction and coagulopathy consumption. This requires treatment in some patients in the intensive care unit (ICU). According to WHO, from 10 to 30% of hospitalized patients with influenza A/H1N1/09 ​​needed treatment in the ICU.

Based on the analysis of the influenza epidemic caused by the A/H1N1/09 ​​virus in 2009, five types of respiratory complications can be distinguished: viral "pneumonitis", exacerbation of bronchial asthma or chronic obstructive pulmonary disease, exacerbation of other chronic diseases, secondary bacterial pneumonia, and bronchiolitis in the pediatric population.

Overall, a secondary bacterial infection was diagnosed in 14–29% of cases.

It should be noted that the majority of patients who passed through the ICU had a viral "pneumonitis", and clinical picture was characterized by progressive hypoxemia and bilateral infiltrates on chest x-ray (manifestations of ARDS). Therefore, a transfer to artificial lung ventilation (ALV) and the use of sufficiently “hard” ventilation parameters were required.

Due to the presence of morphological features in lung damage induced by a viral infection, such lung damage is defined as "viral pneumonitis", although in most publications the authors use the term "viral pneumonia".

Against the background of viral pneumonia and ARDS, nosocomial pneumonia can develop, the etiological structure of pathogens of which was dominated by non-fermenting gram-negative bacteria (P. aeruginosa, Acinetobacter spp.), enterobacteria - producers of extended spectrum beta-lactamase (ESBL) and methicillin-resistant staphylococcus.

At autopsy, three main variants were determined pathological changes:
1) diffuse alveolar damage with alveolar and fibrinous exudate, with the formation of the hyaline membrane syndrome and activated pneumocytes;
2) necrotizing bronchiolitis with the formation of areas of emphysema;
3) diffuse alveolar damage with a pronounced hemorrhagic component, microvascular thrombosis, hemorrhages in the intraalveolar space and submucosa, and interstitial edema.

Clinical picture (symptoms) of swine flu

The incubation period for this disease is two to seven days.

Clinical symptoms are similar to "seasonal" influenza, in most cases the disease is benign, but in some patients there is a gastrointestinal syndrome (nausea, vomiting, diarrhea).

According to WHO data (January 2010), mortality is about 0.9% (among registered severe patients). Among intensive care patients, it reaches 14-40%.

In a number of patients, the onset of the disease is rapid: 2-3 days pass from the first symptoms to a serious condition.

In the second option, in the first 5-7 days, a clinic of a moderate form of SARS is formed. By the end of the first week of illness, the patients may feel somewhat better, which creates the impression of an imaginary well-being. On the 5-7th day, the condition of the patients worsens again, fever, weakness increase, dry cough and shortness of breath appear. It is this variant of the course of the disease that prevails.

An important feature of the pandemic variant of influenza is a more frequent and pronounced lesion of the lower respiratory tract, the ability to develop and rapidly progress to acute respiratory failure due to acute respiratory distress syndrome (ARDS) and pneumonia.

First, there is an increase in the pulmonary pattern, mainly in the lower sections, then a picture of lower lobe pneumonia. Infiltration occurs from one or both sides simultaneously. Further, the clinical and radiological picture deteriorates rapidly, and after 3-5 hours a total darkening of the lungs is determined.

Characterized by a rapid, within a few hours, worsening of the disease: intoxication increases, oxygen saturation decreases, the phenomena of hypoxic encephalopathy and hemorrhagic pulmonary edema increase.

In blood tests, normocytosis or hyperleukocytosis with a shift of the leukoformula to the left, changes in blood gases in the form of an increase in decompensated respiratory and metabolic acidosis are more often recorded.

Diagnosis of swine flu

The main diagnostic method is PCR. Of decisive importance in preventing fatal outcomes of pneumonia is the timely diagnosis of the disease and the stage of respiratory failure using portable pulse oximeters in the emergency room and therapeutic departments with timely transfer to the intensive care unit due to the rapid progression of acute respiratory failure.

Swine flu treatment

In most cases, patients are subject to outpatient treatment with the use of pathogenetic and symptomatic therapy. Treatment is with oseltamivir and antibiotics.

Antiviral therapy is primarily indicated for patients with risk factors for adverse development of the disease:
a) pregnancy
b) overweight (BMI > 30 kg/m2),
c) people with chronic lung diseases ( bronchial asthma, COPD, etc.),
d) concomitant somatic diseases of a severe course (diabetes mellitus, chronic heart, kidney, liver failure, aspirin, immunosuppressants, chronic alcohol intoxication).

Antiviral therapy for swine flu

The antiviral drugs of choice are the viral neuraminidase inhibitors oseltamivir and zanamivir.

Oseltamivir is administered orally in 75 mg capsules or as a suspension prepared from a 12 mg/ml ex tempore powder.

Adults and adolescents 12-17 years old with uncomplicated forms of the drug are prescribed 75 mg twice a day for 5 days. Zanamivir in adults and children over 5 years of age is used in the following regimen: 2 inhalations of 5 mg twice a day for 5 days.

Data on the use of oseltamivir in children under 1 month of age are not available.

Zanamivir can be used in cases of A/H1N1/2009 virus resistance to oseltamivir. According to WHO (2009), the effectiveness of intravenous use zanamivir and alternative antiviral drugs (peramivir, ribavirin) in cases of A/H1N1/2009 virus resistance to oseltamivir.

It should be noted that the maximum healing effect from the use of these drugs was noted only at the beginning of treatment in the first two days of illness.

There is evidence that in patients with severe forms of pandemic influenza A / H1N1 / 2009 with the development of viral pneumonia against the background of standard therapy, a higher intensity of viral replication (viral load) and a prolonged (7-10 days) presence of the virus in the bronchial contents are detected. This makes it reasonable to increase the dose of antiviral drugs (for adults, oseltamivir 150 mg twice a day) and lengthen the course of treatment up to 7–10 days.

Due to the resistance of the A / H1N1 / 2009 virus to M2 protein blockers, the use of amantadine and rimantadine is not advisable.

Outpatient management of patients requires regular monitoring of the dynamics of the manifestations of the disease. Signs of disease progression are:
- increase in body temperature or persistence of high fever for more than three days,
- shortness of breath at rest or physical activity,
- cyanosis,
- Bloody or blood-stained sputum
- Chest pain when breathing and coughing
- arterial hypotension,
- change in mental status.

When the above symptoms appear, specific antiviral therapy and referral of a sick person to a specialized hospital are necessary.

Emergency admission to a hospital is indicated if the following criteria are met:
- tachypnea more than 24 breaths per minute,
– hypoxemia (SpO2< 95%),
- the presence of focal changes on the chest x-ray.

Critical conditions in such patients primarily include rapidly progressive lesions of the lower tracheobronchial tree with the development of viral pneumonia and ARDS with persistent hypoxemia. Features of a severe course of respiratory viral infection are: rapid development (in the first 72 hours) of acute respiratory failure, severe hypoxemia (PaO2< 60 мм рт. ст.), рефрактерность к проводимой complex therapy, high risk barotrauma (pneumothorax) during mechanical ventilation.

Other complications of the disease are secondary infectious processes (pneumonia, septic shock), renal and multiple organ failure, myocarditis, meningoencephalitis, as well as decompensation of concomitant chronic diseases (bronchial asthma, COPD, chronic heart failure). Patients with a severe course, as a rule, noted an increase in the level of LDH, ALT, AST and creatinine, leukopenia and lymphopenia.

When a patient is hospitalized during his initial examination in the conditions of the admission department of a hospital, a comprehensive assessment is necessary clinical manifestations influenza, primarily the nature of the damage to the respiratory system, the degree of compensation for concomitant diseases, the main physiological constants: respiratory rate and pulse rate, blood pressure, blood oxygen saturation (SpO2), diuresis. Mandatory radiography (or large-format fluorography) of the lungs, ECG. A standard laboratory examination is carried out, material is taken for specific diagnostics - RT-PCR, serological reactions (an increase in antibody titer by 4 times or more has a diagnostic value).

During treatment, regular monitoring of key clinical and laboratory parameters is necessary, since in patients who initially show symptoms of uncomplicated influenza, the disease can progress within 24 hours to a more severe form. There are known cases of fulminant development of ARF/ARDS (within 1 to 8 hours) in patients with no predictors of severe influenza.

Indications for transfer to the intensive care unit

The clinical picture of rapidly progressive acute respiratory failure (RR> 30 per 1 min, SpO2< 90%, АДсист. < 90 мм рт. ст.), а также другая органная недостаточность (ОПН, энцефалопатия, коагулопатия и др.).

It is necessary to timely transfer patients to mechanical ventilation, before the progression of hypoxemia, while using high-quality respiratory equipment. The mode of mechanical ventilation should be forced mechanical ventilation of the lungs by pressure (CMV-PC) with mandatory drug synchronization for the first three days and control of blood gases. Transfer to spontaneous breathing should be carried out only with the help of the modes of assisted ventilation of the lungs (SIMV with PSV) with a clear positive clinical dynamics of the disease.

One of the key points in the treatment of viral pneumonia is antiviral therapy, and the basis of empirical antibiotic therapy in intensive care units should be modern antimicrobial drugs that act on the main respiratory pathogens that cause pneumonia, with further correction based on the results of bacterial sputum cultures. The selection of the volume of infusion therapy should be individual, regulated only by the introduction of antibiotics, hormones and dopamine, with early start of enteral nutrition.

Treatment of acute respiratory failure in swine flu

In the ICU, all patients should immediately receive oxygen inhalation through nasal catheters or regular face masks. Start with an average flow rate (5-7 L/min), if necessary, increase to 10 L/min in order to ensure an acceptable level of blood oxygenation (PaO2 over 60 mmHg, SpO2 over 90%). The lack of improvement in the condition of patients with the remaining “borderline” gas exchange indicators may serve as a basis for the use of non-invasive mechanical ventilation through a nasal mask according to generally accepted rules with careful monitoring of the PaO2 level or the SpO2 value.

If there are indications, the transfer to mechanical ventilation should be carried out immediately (respiratory rate more than 35 per 1 min, decrease in PaO2 less than 60 mm Hg, decrease in SpO2< 90% и нарушение сознания на фоне инсуфляции кислорода). При этом следует иметь в виду, что прогрессирование дыхательной недостаточности может происходить чрезвычайно быстро.

As a rule, parenchymal damage to the lungs in A/H1N1/2009 influenza is accompanied by a decrease in the extensibility of the respiratory system due to a decrease in lung volume, loss of surfactant, and interstitial edema. Parenchymal damage may also involve the airways, especially the bronchioles and alveolar ducts. Their narrowing and collapsing contribute to the deterioration of the ventilation of the damaged parts of the lungs. The main pathophysiological mechanism of impaired oxygenation in parenchymal damage is associated with a violation of the ventilation-perfusion relationship, the development of a shunt.

The strategic goal of respiratory support in this type of parenchymal lung injury is to ensure adequate gas exchange and minimize potential iatrogenic lung injury.

When choosing a ventilation mode, the clinical decision is made primarily on the basis of four important factors: possible overdistension of the lungs by volume or pressure, the degree of arterial saturation of hemoglobin with oxygen, arterial pH, fractional oxygen concentration (toxic effects of oxygen).

Regional hyperextension of the lung tissue can be carried out in two ways: 1) with repeated closing and opening of damaged alveoli that collapse on exhalation (atelectasis injury); 2) with excessive overextension of the lungs at the end of inspiration due to a large tidal volume or high PEEP.

The parameters and modes of mechanical ventilation, in which excessive stretching of the alveoli occurs, cause or aggravate tissue edema and damage to these structures. In accordance with this, it is required: a) to restore gas exchange in the "recruited alveoli" with the help of PEEP; b) avoid overdistension of healthy alveoli during the inspiratory phase by focusing on plateau pressure or inspiratory pressure during pressure-controlled ventilation (no more than 30–35 cm H2O).

In ARDS in the presence of viral pneumonia, the use of pressure-controlled mandatory ventilation is probably the preferred option, since it is more effective than volumetric ventilation to limit maximum expansion in all ventilated units to a predetermined level, regardless of regional changes in the lungs. Other potential benefits of pressure-controlled ventilation are higher mean pressure (due to higher initial inspiratory flow rate and faster setpoint pressure) and better matching of inspiratory flow to patient demand (if spontaneous breath attempts are maintained).

Due to the risk of overstretching of the lung tissue in case of severe lung injury and the need to limit the supplied volume (pressure), it can be considered acceptable to reduce the level of hemoglobin oxygen saturation (SpO2) to 88%. Oxygen tension in arterial blood should be maintained within 55–60 mm Hg. Art., to minimize the effect of pulmonary vasoconstriction, and the pH value is not lower than 7.2 (against the background of possible hypercapnia). This pH level correlates with an increase in PaCO2 to 70–80 mm Hg. Art. (“tolerable hypercapnia”). Meanwhile, this tactic should be carried out with extreme caution, especially in patients with CNS pathology and unstable hemodynamics (with inotropic support or cardiac arrhythmias).

The exact concentration in the supplied air mixture of oxygen, at which it becomes toxic, is unknown. The FiO2 level of 0.5–0.6 is considered acceptable.

In case of severe lung injury, forced and forced-assisted ventilation is mainly used, for example, CMV-PC, CMV-VC, AssistCMV, IMV, SIMV modes. This approach ensures that the ventilator does most of the ventilation work. The use of triggered ventilation (eg, AssistCMV) and spontaneous breathing support modes (SIMV + PS, BIPAP) allow the patient to initiate additional breaths, which can help achieve CO2 levels and improve patient comfort. In cases where there are critical values ​​of gas exchange and respiratory mechanics, as well as desynchronization of the device with the patient's breathing, preference in respiratory support should be given to forced ventilation with adequate sedation and/or the use of muscle relaxants.

Sedation or myoplegia is also necessary when using an unnatural breathing pattern (long breath) or high peak pressure. If the lung damage is not very severe or there is a positive trend in the patient's condition, assisted ventilation is used with a gradual decrease in ventilation support so that the patient takes on some of the work of providing ventilation. With partial support, there is usually less peak pressure and less sedation is required.

The tidal volume and PEEP should be adjusted so that the plateau pressure does not exceed 30–35 cmH2O. Art. (or inspiratory pressure if pressure-controlled ventilation is used). To maintain this pressure, it may be necessary to reduce the tidal volume to 5–6 ml/kg instead of the traditionally used 8–10 ml/kg. The selection of the respiratory rate, as a rule, is carried out according to the level of PaCO2. The initial respiratory rate is usually 12–18 per minute.

Increasing the frequency and, accordingly, minute ventilation leads to an increase in CO2 excretion. At some point, however, there is a delay in gas elimination ("air trap") due to inadequate expiratory time. In this situation, pressure-controlled ventilation decreases minute ventilation, while volume-controlled ventilation increases airway pressure. As a rule, the occurrence of auto-PEEP is noted at a respiratory rate of more than 20 per minute.

The choice of the optimal value of PEEP, based on the possibility unwanted effects of this mode is based on gas exchange indicators (PaO2, PaCO2, SpO2), achievement of the highest value of static lung compliance or the level of oxygen delivery to tissues. You can use the so-called "decreasing" option for selecting PEEP. The alveolar recruitment maneuver must first be performed and the inspiratory pressure (pressure above PEEP) adjusted so that the tidal volume is approximately 6–8 ml/kg.

The alveolar recruitment maneuver is carried out by setting PEEP at a level of 20 cm of water. Art. and inspiratory pressure - 20 cm of water. Art. (from the level of PEEP) in the mode of forced valve ventilation with pressure control for 2–3 minutes (it is preferable to use ventilation modes with pressure control). If there is no effect, higher pressure levels can be used (Ppic up to 60 cm of water column, PEEP of 20–25 cm of water column). Then a certain level of inspiratory pressure is set (tidal volume 6-8 ml / kg) and, gradually changing PEEP (step 1-2 cm of water column), the level of PEEP is determined when pulmonary-thoracic compliance or oxygenation indicators are the highest. PEEP values ​​that are optimal in terms of the mechanics of breathing and oxygenation may not coincide. If it is necessary to use a high level of PEEP in order to avoid overdistension of the lungs, it is necessary to maintain SpO2 at the level of 88–90% (PaO2 60–65 mm Hg). The effect of PEEP on gas exchange appears slowly, sometimes within a few hours. At the same time, even a short-term decrease in airway pressure can lead to a critical deterioration in oxygenation. An unreasonably long depressurization of the circuit and a decrease in airway pressure should be avoided, even when performing the necessary medical procedures (bronchoscopy, sanitation of the tracheobronchial tree).

Indications for the maneuver of "opening" the alveoli are:
critical hypoxemia,
the lack of a sufficient effect from the optimization of the respiratory pattern and / or the use of non-respiratory treatments for ARF;
the period after episodes of "respiratory distress" and / or invasive manipulations (transportation, fibrobronchoscopy, tracheostomy, reintubation, secretion aspiration, etc.);
use as a method for optimizing PEEP.

The optimal effect of the maneuver of "opening" the alveoli in most cases is observed only on early stages ARDS.

It should also be emphasized that during prolonged mechanical ventilation, the risk of developing pneumothorax increases significantly.

Absolute contraindications for performing the lung opening maneuver are:
pneumo-/hydrothorax,
bullous changes in the lungs,
high risk of development and / or recurrence of pneumothorax,
lack of modern ventilators,
insufficient monitoring,
severe hypovolemia.

Techniques that improve oxygenation include inverting the ratio of inspiratory and expiratory times. A prolonged inspiratory time (without developing auto-PEEP) can increase the mean alveolar pressure without changing the maximum alveolar pressure. It is believed that the lengthening of the inspiratory time leads to an increase in the time of gas mixing in the alveoli, an improvement in the ventilation of poorly filled alveolar units, and the recruitment of a part of the alveoli.

The effect of this technique and its impact on the outcome of acute lung injury is not fully understood.

It is known that if the expiratory time becomes inadequate (short), autoPEEP develops, and venous return sharply decreases.

Internal (auto-) PEEP, however, is difficult to assess. If the inspiratory time is not set adequately, it can affect the ventilation parameters.

In volumetric ventilation, auto-PEEP increases peak pressure, and in pressure-controlled ventilation, it decreases tidal volume.

In addition, an increase in the inspiratory to expiratory ratio of more than 1:1 (or an inhalation time of more than 1.5 s) is extremely uncomfortable for the patient. Usually in these cases, additional sedation and myoplegia of patients are required if they have not been resorted to before. In this regard, an increase in the ratio of inhalation to exhalation of more than 1: 1 is not advisable.

A certain improvement in gas exchange can be achieved by periodically changing the position of the ventilated body (prone position) by turning him on his stomach (for 4–12 hours) and back on his back.

There is a positive experience in the use of extracorporeal oxygenation, IVIVL and nitric oxide in critical disorders of gas exchange against the background of viral pneumonia. Improvement in oxygenation (by 4-6 hours) can also be achieved with the use of a surfactant, although the effectiveness of this method of treatment for ARDS of other etiologies has not been proven. However, in persistent refractory hypoxemia, it seems that this additional method of maintaining oxygenation should still be considered.

Thus, in patients with ARDS against the background of viral pneumonia with influenza A / H1N1 / 2009, it is initially most advisable to carry out mechanical ventilation in the mode of forced ventilation of the lungs with pressure control (PCV, SIMV (PC), BIPAP) with an adequate level of PEEP (if necessary up to 15–20 cm wg and above) under the control of gas exchange and respiratory mechanics. It should be adjusted for long-term ventilation of the lungs (2-4 weeks).

The simplification of the ventilation mode should be carried out gradually, first by reducing FiO2, then by a gradual decrease in PEEP.

Given the duration of ventilation, patients can undergo a tracheostomy.

The decision on the operation is best taken on the 7-10th day, when, on the one hand, the further course of the process becomes clear, and on the other, some stabilization of gas exchange occurs.

Prerequisites for enabling auxiliary ventilation modes. Before starting the weaning process from the ventilator, the general state sick. Any identified deviations of homeostatic indicators, if possible, should be reduced to acceptable values.

When deciding to stop mechanical ventilation, attention is paid to mechanical and neuromuscular capabilities. respiratory system, as well as the ability of the lungs to adequate oxygenation of arterial blood without the support of the apparatus (PaO2 more than 60 mm Hg with FiO2< 0,3, SрО2 не ниже 95%, частота дыхания менее 25 в минуту при величине поддержки давлением не более 8–10 см вод. ст.).

Transfer to spontaneous breathing.

Spontaneous breathing refers to the process of gradually reducing the level of respiratory support using assisted ventilation modes. Transfer to spontaneous breathing can take more than 40% of the total time spent on mechanical ventilation, so the role of the correct tactics for this stage is extremely large.

The initiation of transfer to spontaneous breathing (the use of assisted ventilation and spontaneous breathing modes with a gradual decrease in the proportion of hardware support) can only be started when PaO2 is more than 60 mm Hg. Art., and SpO2 above 95% against the background of ventilation with an air-oxygen mixture with FiO2 0.3–0.4 and a decrease in PEEP to 10–12 cm of water. Art.

Another criterion for the success of the transition to spontaneous breathing is the value of the inspiratory index. This index is calculated by dividing the respiratory rate by the tidal volume in liters. A rapid increase in the index value > 100 after the transition to spontaneous breathing indicates questionable success. With an index value of less than 100, the probability of a successful transition to spontaneous breathing is quite high.

Before extubation, it is useful to once again debride the tracheobronchial tree. After disconnecting from the respirator, it is imperative to continue supplying humidified oxygen through the face mask at a flow rate of 4–6 l/min.

After the patient is transferred to fully spontaneous breathing, he needs to be carefully observed and monitored for at least the next 24 hours. In this case, the spontaneous tidal volume should be at least 5 ml / kg with a respiratory rate of less than 25 times per minute. Patients who require ventilation of more than 10 L/min usually cannot provide such ventilation without fatigue of the respiratory muscles.

Glucocorticosteroids

In the case of refractory shock, especially in combination with ARDS, it is reasonable to use low doses of steroids: hydrocortisone - 300 mg / day or methylprednisolone - 1 mg / kg bolus followed by a daily infusion of the same dose.

Antibacterial therapy for swine flu

Taking into account the nature of the pathological process in the lungs and the severity of the condition in patients with a favorable premorbid status in the first days of the disease antibacterial drugs not shown.

In individuals with acute lung injury syndrome, it is not possible to exclude an association with a bacterial infection at the time of admission. In addition, in some cases, the diagnosis of influenza may be misdiagnosed and pneumonia is associated solely with a bacterial infection. In this regard, along with antiviral therapy, the appointment of antibiotics according to the protocol for the treatment of severe community-acquired pneumonia, according to which a combination of 3rd generation cephalosporins with antipneumococcal activity (ceftriaxone - 2.0 g / day or cefotaxime 6.0 g / day) with macrolides (azithromycin 0.5 g / day or clarithromycin 0.5 g each) should be used twice a day). Alternatively, respiratory fluoroquinolones such as moxifloxacin 0.4 g/day or levofloxacin 0.5 g twice daily, with or without ceftriaxone, may be considered.

If it is possible to exclude the presence of a bacterial infection by clinical and laboratory signs and data microbiological research antibiotics should be discontinued. Mechanical ventilation should not serve as a basis for prescribing antibiotics for prophylactic purposes.

In cases of hospital-acquired (nosocomial) pneumonia, including ventilator-associated pneumonia, the choice of an empiric antibiotic regimen is carried out in accordance with the microbial landscape of a particular hospital/department and the pathogen resistance phenotype. Possible regimens include: carbapenems (meropenem, imipenem, doripenem), piperacillin/tazobactam, cefaperazone/sulbactam. With a high prevalence of MRSA in the ICU (> 20% in the etiological structure), it is advisable to add vancomycin or linezolid to the indicated drugs. Upon receipt of results bacteriological research the need to correct the chosen starting scheme is considered.

Brief description of the clinical management of patients with pandemic influenza A/H1N1/09 ​​infection

Prevention of swine flu

Prevention measures are the same as for the "seasonal" flu. When in contact with a patient, oseltamivir is indicated. Vaccines exist, but they are ineffective.

Specific prophylaxis

Because no individual can predict which and how many circulating influenza viruses will infect them, the trivalent seasonal influenza vaccine will provide the broadest protection. However, trivalent vaccine is not available in some areas, and to prevent serious illness, it may be appropriate to vaccinate against the H1N1 virus.

Swine flu is an acute and serious infectious disease of humans and animals, which causes the type A influenza virus. The main danger of the disease is the development of severe complications.

The disease is so named because it is the most common and was first discovered in pigs.

Swine flu is transmitted both from sick animals and from carriers by airborne droplets and contact. In most countries where the incidence is high (Mexico, European countries, America, Japan, China), pigs are vaccinated against influenza A H1N1.

The relationship between swine flu and humans:

The main feature of the H1N1 type A influenza virus is the highest level of variability and the ability to permanently mutate. Emerging new types of H1N1 influenza virus cause disease not only in pigs, but also in humans. As the changes take place, the virus becomes more active, aggressive and causes the most severe forms of influenza in humans with a fairly high number of deaths. In addition, the very high rate of spread of infection from person to person leads to the emergence of pandemics (the defeat of a huge number of people).

Due to the constant variability of the influenza A virus, it is very difficult to develop a fully effective vaccine.

What are the ways of human transmission of swine flu?:

Contrary to popular belief, human infection from diseased pigs is unlikely. This is also the case with pork, which people eat. There is practically a very low probability of human infection if the meat has been properly cooked. Raw, undercooked meat is potentially dangerous and increases a person's risk of contracting H1N1 swine flu.

The main routes of transmission of swine flu between people are as follows:

1. Airborne. The infection spreads with saliva, sputum, exhaled air of an infected or carrier of the influenza virus when coughing, active emotions (drops of saliva are released into the surrounding air), sneezing, blowing your nose. In open space, the influenza virus persists for several minutes;

2. Contact. This is a way of infection through common objects used by a sick person or a carrier of the virus. It is especially important to avoid contact of children with toys and other objects in public places where you cannot be sure of the quality of their disinfection.

Remember, crowded places are always an increased risk of infection with a dangerous swine flu virus, especially in autumn-winter period!

What is the carriage of the virus and its duration:

Carriage of the virus is the period when a person releases the swine flu pathogen into the environment and is dangerous to others.
With swine flu, the carrier period lasts from the second day of the incubation period (the second day of the disease) until the end of the febrile period (fever). As a rule, the duration of the carriage is about one week. After this time, the amount of influenza virus in the exhaled air rapidly decreases and the person becomes harmless to others.
The main threat to healthy people is borne by people who do not stay at home during illness and continue to visit public places.
It is important to understand that the swine flu virus spreads instantly among people. A few minutes of communication with the carrier is enough, and the likelihood of infection increases many times over.

Features of the manifestations of swine flu in children:

Swine flu is characterized by an acute onset. This is an important diagnostic feature. Parents note that just a few hours ago the child was actively playing, and now his condition has deteriorated sharply.
Swine flu never occurs in an erased or mild form.

When the first symptoms are detected, it is very important to consult a doctor as soon as possible. Laboratory tests of a swab from the pharynx and nasopharynx will help to accurately establish the diagnosis (allows you to isolate parts of the H1N1 type A virus), as well as a study of blood serum to determine the level of immunoglobulins M, G. An increase in their number by more than 4-5 times indicates infection with the influenza virus.

Symptoms of swine flu in children?:

After an incubation period that lasts 2 days (less often 3), a feverish period begins, which is characterized by the following manifestations:

1. A sharp increase in the patient's temperature up to 40⁰ C (in some especially severe cases and higher);
2. severe weakness;
3. Feeling of heat;
4. Increased sweating;
5. Photophobia, pain in the eyeballs and brow ridges;
6. Severe pain in the muscles and bones;
7. Headaches;
8. Appetite is greatly reduced or completely absent.

In most cases, the duration of the period of hyperthermia is up to 5 (rarely 7) days. On the 2nd day of the febrile period, the so-called catarrhal manifestations of the disease join. These include the following:

Redness and swelling soft palate, as well as the back wall of the pharynx;
Sore throat, as well as when swallowing;
Swelling and redness of the conjunctiva;
Nasal congestion and runny nose. The nature of the discharge may be different. More often they are mucopurulent.
Cough. In most cases of swine flu, the cough is dry and very painful. In some, more rare cases, the cough becomes wet, but unproductive (the amount of sputum is small);
Voice changes. He becomes hoarse and deaf - the natural sonority is lost;
Minor nausea and vomiting;
loosening of the stool;
Feeling of heaviness and discomfort in chest;
Shortness of breath that is adequately tolerated and does not cause severe discomfort.

If the disease develops without complications, then recovery occurs in 8-10 days. For 3 weeks, the baby still has post-infection manifestations:

Increased fatigue;
lethargy;
Apathy;
sleep disorders;
Headaches.

Signs that indicate a deterioration in the child's condition:

If a child has such signs, then this indicates a significant deterioration in the course of the disease and requires additional qualified assistance:

1. Bluish skin tone;
2. Rapid breathing;
3. Sufficiently severe shortness of breath, which is noted even at rest;
4. Severe cough with copious excretion sputum;
5. Severe pains in the chest, both during coughing and in the intervals between attacks;
6. Frequent bouts of vomiting;
7. Convulsions;
8. Violation of consciousness;
9. A significant decrease in the amount of urine excreted, which indicates a severe dehydration of the child's body;
10. Decrease blood pressure;
11. Preservation of a very high temperature for more than three days without positive dynamics. Taking antipyretic drugs is ineffective;
12. The kid completely refuses food;
13. A second wave of symptoms appears against the background of an improvement in the child's condition.

Lung lesions are dangerous complications of H1N1 flu:

A life-threatening complication of the disease - syndrome of segmental lung tissue damage . This condition is characterized by a very rapid development of pulmonary and heart failure (within 2-3 hours) with impaired breathing and oxygen supply and nutrients the whole body of the child. With timely assistance to the child, changes in the lung x-ray (shadow) completely disappear after three days. This is an important difference between this complication and pneumonia.

Pneumonia - no less dangerous and very common complication of swine flu. Pneumonia in this disease can be of two types:

Primary. The main difference is that this form of pneumonia develops 2-3 days after the onset of the disease. Severely rapid breathing (more than 30 breaths per minute), severe dry cough, difficulty breathing, shortness of breath and cyanosis of the skin may indicate that the child has primary pneumonia. It is important to understand that it is this form of pneumonia against the backdrop of swine flu that often leads to pulmonary edema and death!;

Secondary. It occurs as a result of a layering of a bacterial infection on the 7-10th day of swine flu. The most common pathogen is pneumococcus or staphylococcus aureus. Characteristic is the increase in cough against the background of an objective improvement in the child's well-being. At the same time, a recurrence of the febrile period occurs (it seems to the parents that the disease is recurring). The child completely refuses to take food and water. There is a growing pain in the chest, not only during coughing, but also when inhaling. Secondary pneumonia in swine flu is a protracted condition that takes about 1.5 months to heal. The main danger of secondary pneumonia is a lung abscess.

In especially severe cases, children may develop mixed forms of complications against the background of swine flu, when both primary and secondary pneumonia develop. This condition is very difficult to treat and often fatal.

Other complications of swine flu:

Frequent complications of infection from the heart:

Pericarditis;
Myocarditis.
These diseases, if untimely started treatment, lead to the development of acquired heart defects in children.

From the side of the central nervous system such dangerous diseases develop:

Meningism - a combination of several signs of meningitis in the absence of pronounced inflammatory processes in the meninges;
encephalopathy. This is a common complication of swine flu in children. This condition is always combined with severe circulatory disorders and is called neurotoxicosis. It is a common cause of death in children with severe forms of swine flu;
Edema of the brain. It occurs quite rarely.

Watch your children carefully. If you have single suspicious symptoms, consult a doctor in a timely manner!

Modern man cures a cold in a few days. Influenza virus diseases of the latest strains are treated much more slowly and more severely. They are extremely dangerous and often cause serious complications. This also applies to the H1N1 influenza virus in humans. Until now, doctors have not been able to create a universal medicine that effectively treats swine flu.

During the conversation, you will learn what swine flu is, symptoms in people, methods of treatment and prevention for adults and children.

The H1N1 virus infects the respiratory tract and is transmitted by airborne droplets. The incubation period of infection is 4 days.

Humans and animals are susceptible to infection, most of all pigs. In the middle of the twentieth century, the virus was transmitted from animals to humans extremely rarely. At the end of the 20th century, the swine flu virus began interacting with human and avian influenza. The result was another strain, designated H1N1.

The first symptoms of the disease in humans were reported in North America. In 2009, doctors discovered the virus in a 6-month-old Mexican baby. After that, similar cases began to appear in all parts of the continent. Now the swine flu virus is easily transmitted between people, since the human body does not have immunity to this strain, which greatly increases the likelihood of total spread and epidemics.

According to experts, the H1N1 strain is a descendant of the “Spanish flu”, which claimed the lives of 20 million people at the beginning of the past century.

Symptoms

• Sudden and rapid rise in temperature up to 40 degrees. Often accompanied by severe chills, weakness and general weakness.
• Pain in muscles and joints. Headache localized in the region of the eyes and forehead.
• On the initial stage dry cough in the form of constant attacks, subsequently replaced by a cough, with poorly separated sputum.
• Often accompanied by a pronounced runny nose and strong painful sensations in the throat area.
• Decreased appetite. Nausea with vomiting and diarrhoea.
• Shortness of breath and severe pain in the chest.

Complications

• Pneumonia.
• Cardiovascular and respiratory failure.
• Damage to the nervous system.
• development of comorbidities.

• Treatment of swine flu is always under the supervision of doctors. It is possible that at the final stage you will be allowed to continue treatment at home. True, you will have to follow strict rules.
• After a discharge approved by the doctor, it is necessary to adhere to bed rest, take medicines regularly and in accordance with the instructions of the doctor, and stop walking.
• Increased attention should be paid to hygiene.

In general, if symptoms of this scourge appear, go to the clinic. Only a doctor can make a diagnosis and prescribe medicines. There is only one conclusion - hospitalization and no self-treatment.

Are there home remedies for swine flu?

As you already understood, it will not work to cope with the disease on your own.

Doctors warn that the H1N1 flu should only be fought in a hospital setting with the use of antiviral drugs and antibiotics.

1. Tests conducted by scientists have shown that antioxidant-rich foods such as red wine, blueberries, cranberries, and pomegranates help treat swine flu.
2. In order for the body to counteract the disease, it is necessary to eat a plant-based diet and take vitamins.
3. Refusal of cigarettes, compliance with the regime of wakefulness and sleep, proper hygiene and the absence of stressful situations will help to treat the disease.

Real folk remedies, which are prepared from various oils, herbs and decoctions, have not yet been created. Surely, this is due to the fact that the disease itself is young and all efforts are directed to its study.

Prevention: how not to get swine flu

Vaccination is considered the most effective preventive method for swine flu. But, not every person can make a vaccination injection in a timely manner. In this case, generally accepted rules for protecting against viruses will help.

• During an epidemic, it is necessary to wear a gauze bandage, especially if you are constantly in contact with people. It is recommended to wear a stretched and well-ironed bandage. Such a protective agent lasts for several hours, after which it needs to be changed.
• Within the framework of an unfavorable period, if possible, refuse to visit crowded places. The list of dangerous places where the probability of infection is high is represented by public transport, shops, offices, shopping centers, museums, theaters.
• It is recommended to refuse contact with a person with pronounced symptoms of a respiratory infection.
• A highly effective preventive measure is regular wet cleaning. Wash your hands with antibacterial soap as soon as possible.
• Eat right, sleep well and exercise. Take vitamins.
• Remember, the causative agent of swine flu is not friendly with high fever. High-quality heat treatment leads to the death of a dangerous virus.
• Do not come into contact with homeless animals, as the virus can be transmitted from them.

I hope you learned something new, interesting and informative in this article on swine flu. I want you to never experience this problem and always feel great!

Swine flu. This diagnosis plunges the entire population into panic and horror - it is believed that this disease is very difficult and at best leads to complications, and at worst ends in death. And what does science know about swine flu and how to prevent its occurrence?

Introduction to Influenza A (H1N1)

It is believed that the outbreak of swine flu falls on the New Year holidays - people stay at home for a long time, their number decreases due to the consumption of large amounts of fatty foods and alcoholic beverages. By the way, it is precisely in connection with the presence of people in their homes that cases of influenza with severe complications are recorded very often - patients turn to doctors already in a critical condition.

Note:year after year, the same pattern repeats itself: first, the influenza B virus rages, then the flu begins to appearH1N1, but it quickly "burns out" and again comes the influenza B virus, which can infect people sluggishly. And even the period of such a wave-like infection occurs every year at the same time - from January to March.

A large percentage of swine flu cases was observed in 2009 - then deaths were recorded, and the severe course of the infection was clearly visible. Doctors predicted an outbreak of influenza A (H1N1) in 2016 in advance, this strain was incorporated into which a large number of people were vaccinated - this made it possible to create a good immune layer among the population. And yet, since the beginning of 2016, dangerous swine flu began to spread actively in the countries of the Northern Hemisphere - Russia, Ukraine, Turkey, Israel.

swine flu symptoms

The danger of the disease in question lies in its rapid development, so everyone needs to know the symptoms of swine flu clearly. These include:

1. Severe intoxication of the body, which always manifests itself suddenly - the patient can literally name the hour when he felt ill.
2. Hyperthermia is a high body temperature, which can reach critical levels.
3. Headache of a sharp nature, intense - the patient is irritated by bright light, noise and any movement.
4. Problems in the functioning of the respiratory system - patients complain of a dry cough that has appeared.
5. General weakness, accompanied by aching throughout the body.
6. Sensation of compression of the lungs - patients complain of severe pain behind the sternum, the inability to take a deep breath and exhale.

It is extremely rare that among the symptoms of influenza A (H1N1) there are a runny nose and.

There is a selected group of people who are at risk for infection with the influenza A virus. It includes:

• children under the age of 5;
• pregnant women;
• people over the age of 65;
• patients with previously diagnosed chronic pathologies - for example, pulmonary diseases, kidney problems, and so on;
• people with diabetes and heart disease;
• patients with pronounced obesity.

Why swine flu is dangerous

It is influenza A (H1N1) that poses a particular danger to human health and life - this disease is characterized by the development of severe complications. These include:

1. Changes in the structure of the blood - it becomes thicker, clotting increases, and the risk goes to the highest level.
2. Within 1-2 days, swine flu turns into a viral one, which is often accompanied.
3. The influenza virus has a detrimental effect on the kidneys - this can provoke the development of nephritis.
4. The myocardium of the heart is negatively affected by the virus.

Note:it is viral pneumonia, which develops rapidly against the background of swine flu, literally within a few hours / days, most often leads to the death of the patient.

Head of Rospotrebnadzor Anna Popova:

“That is why, literally on the very first day, constant monitoring by a doctor is necessary: ​​call him at home, because only a specialist can prescribe adequate treatment. Many regions where the active spread of influenza has already begun are introducing such a practice - a patient with a confirmed diagnosis of influenza does not go to the hospital every five days to extend the sick leave, but every day he describes his condition to the attending physician in SMS messages. In no case should the condition be allowed to worsen, if a person feels that he is breathing with difficulty, urgent hospitalization is necessary. ”

How to recognize swine flu

Sometimes it is very difficult to immediately determine the development of swine flu - many patients take its symptoms for signs of a common cold or an acute respiratory viral infection. This entails inadequate treatment, omission of the first hours of the disease and the development of severe complications.

The following table will help you distinguish between the symptoms of swine flu and a common cold:

Features of the course of influenza A (H1N1)

It is worth knowing that swine flu is transmitted by airborne droplets - you can become infected by being close to a sick person who sneezes and coughs. For example, in a movie theater, influenza viruses, when sneezing from an already sick person, spread 10 meters around.

Virologists identify several distinctive features swine flu:

1. Headaches are localized in the forehead - patients complain of heaviness of the superciliary arches. Even a simple attempt to open the eyes, lift the eyelids completely, leads to intense pain of a boring nature in the eyeballs.

Note:if the child is preschool age with symptoms of a cold begins to complain of pain in the head, then immediately call a doctor - headaches are not typical for preschool children .

1. If a patient with a cold has a history of diseases of the heart system or, then with complaints of profuse cold sweat against the background of high body temperature and difficulty in breathing, an ambulance team should be called. This is a sign of the development of swine flu, and it is for cores and hypertensive patients that it rapidly turns into viral pneumonia with pulmonary edema.
2. Influenza A (H1N1) is characterized by respiratory failure - the patient cannot take a deep breath, he is tormented by a constant feeling of lack of air, the breathing rhythm becomes very fast.

Complications against the background of swine flu can affect almost every organ:

Important nuances

There is a lot of controversy about how to behave when the first symptoms of swine flu appear. But the main recommendations of doctors are as follows:

1. Don't hit too hard high temperature. An increase in temperature is a signal that the body's immune forces have entered the fight against infection. But too sharp a jump has a bad effect on the work of the heart. The threshold is 38 degrees Celsius. If the flu temperature is up to 38.5 degrees (for young children - up to 38 degrees), it is better not to take anything antipyretic. If higher - use drugs with paracetamol, ibuprofen, if there are no contraindications. If the temperature does not decrease, urgently call the ambulance team, be sure to report on the measures taken, and that the fever does not subside.
2. There is no antiviral food and drink, no matter how pseudo-useful notes in social networks are presented to us. But step up immune system will help:

• natural fermented milk products (low-fat yogurt, ayran, tan),
• citrus fruits (this is already a classic: for patients - a mesh to raise their spirits, and preferably lime in tea and a day - they also help the heart survive influenza stress). , which they are rich in, and pectins help to remove sputum from the lungs, reduce the risk of congestion.
• fruit drinks of all kinds (from lingonberries, currants), except for sweets (excessive sugar prevents the removal of viruses from the body).
• natural proteins that are easy to digest and strengthen the heart - eggs, chicken breast, rabbit, fish.

1. Self-medication is not worth it - the result will be disastrous. Yes, it is possible and necessary to provide the patient with plenty of fluids, but no medicines cannot be accepted! Usually, for severe swine flu, doctors prescribe medicines antiviral action, but they are selected individually. If the situation requires resuscitation, the presence of medical workers next to the patient will save his life.

What to do as part of prevention

When the season of mass infection with the influenza A (H1N1) virus begins, it is worth taking certain preventive measures - they will help reduce the risk of infection at times. Virologists make the following recommendations:

1. You should not visit crowded places - theaters, discos, cinema centers, shopping centers and the like should be excluded from your routine.
2. After visiting various institutions, staying on the street and in public transport, wash your hands with soap and water, be sure to have special disinfectant wipes with you - you can wipe your hands and face with them.
3. Rinse your nose with saline as often as possible throughout the day. Sprays can be an alternative. sea ​​water- they are sold in pharmacy chains and have quite an adequate cost.
4. Before you leave the house and go to work or any other place, lubricate the nostrils (the direct entrance to the nose) with oxolin ointment - a barrier will be provided to viruses.
5. A medical mask is not a panacea for the flu. Viruses are so small that they penetrate through the smallest pores. But how additional remedy security is quite good, especially if you need to move around and communicate a lot. Tip: wear a mask only in transport or in a closed area where there are a lot of people. In the open air, the chance of infection is minimal, so do not torture yourself.
6. The house or office should be ventilated daily, and each procedure should take at least 15 minutes. Remember - swine flu spreads only in a warm and dry room, he is afraid of cold and dampness.

Swine flu is a dangerous disease that can lead not only to serious consequences, but also to the death of the patient. Only an immediate appeal to doctors for help, the strict implementation of all the recommendations and appointments of specialists can prevent such a development of events. By the way, if swine flu occurs in a mild form, then the disease disappears within 1-3 weeks without any consequences in the future.