Critical Care Management of Influenza-Related Respiratory Conditions

Severe influenza infection remains a leading cause of viral pneumonia and acute respiratory distress syndrome (ARDS) in intensive care settings worldwide. Management begins with prompt recognition of respiratory compromise and assessment of disease severity, often guided by the PaO2/FiO2 ratio to determine the degree of hypoxaemia. Standard supportive measures include early initiation of neuraminidase inhibitors and meticulous fluid balance to limit pulmonary oedema while preserving end-organ perfusion. Lung-protective ventilation strategies—characterised by low tidal volumes and limited inspiratory pressures—aim to mitigate ventilator-induced lung injury, and may be complemented by prone positioning in cases of refractory hypoxaemia. Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy for patients with very low oxygenation despite optimal ventilation. Immune dysregulation, often manifesting as a hypercytokinaemia, underpins the progression to severe lung injury, prompting investigation of immunomodulator therapies such as corticosteroids or intravenous immunoglobulin to attenuate aberrant inflammatory cascades. Multidisciplinary approaches, incorporating microbiology, respiratory therapy and haemodynamic monitoring, are essential for individualised care. Global experience has underscored the importance of rapid antiviral administration, refined ventilatory management and judicious use of immunomodulation to improve survival and reduce long-term pulmonary sequelae.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Critical Care Management of Influenza-Related Respiratory Conditions publication trend

The graph below shows the total number of articles in critical care management of influenza-related respiratory conditions across all publications each year (not limited to Nature Index journals).

Technical terms

Acute respiratory distress syndrome (ARDS): A form of severe lung injury marked by rapid onset of non-cardiogenic pulmonary oedema and refractory hypoxaemia.

PaO2/FiO2 ratio: The arterial oxygen tension (PaO2) divided by the fraction of inspired oxygen (FiO2), used to quantify severity of hypoxaemia.

Neuraminidase inhibitors: Antiviral drugs that block the influenza neuraminidase enzyme, preventing release of newly formed viral particles.

Lung-protective ventilation: A strategy using low tidal volumes and restricted airway pressures to reduce ventilator-induced lung injury.

Extracorporeal membrane oxygenation (ECMO): A technique that oxygenates blood outside the body, supporting gas exchange in cases of severe respiratory failure.

Immunomodulator therapy: Treatments such as corticosteroids or intravenous immunoglobulin aimed at regulating exaggerated inflammatory responses.

References

1. How to manage antivirals in critically ill patients with influenza?. Clinical Microbiology and Infection (2025).
2. Clinical aspects and cytokine response in severe H1N1 influenza A virus infection. Critical Care (2010).
3. Effect of low‐to‐moderate‐dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia. Influenza and Other Respiratory Viruses (2017).
4. The influence of corticosteroid treatment on the outcome of influenza A(H1N1pdm09)-related critical illness. Critical Care (2016).
5. Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator Therapy. International Journal of Molecular Sciences (2017).