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Analysis And Comment

Hard decisions will have to be made: view from intensive care

BMJ 2006; 332 doi: (Published 30 March 2006) Cite this as: BMJ 2006;332:790
  1. Richard Marsh, consultant in anaesthesia and critical care (
  1. 1 Northampton General Hospital NHS Trust, Northampton NN1 5BD

    Human mortality from the H5N1 strain of influenza has been high even when antiviral drugs have been used. In most cases death has been due to respiratory failure leading to multisystem failure.1 These conditions can be managed by mechanical ventilation and organ system support in intensive care units. Such treatments were not generally available during the previous influenza pandemics in 1918, 1957 and 1968, and they will hopefully reduce the excess mortality if the H5N1 strain produces a pandemic. This will be possible only if the limited critical care resources in the UK are used effectively.

    Disappointingly, the Health Protection Agency's pandemic plan for influenza does not mention intensive care,2 although the Department of Health has established a critical care contingency planning group. Critical care networks have also been asked to assess the scope for increasing critical care capacity in an emergency.

    Demand for intensive care

    We can estimate the extra demand for intensive care from predictions of the likely extent of the epidemic. The Health Protection Agency …

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