6 Alabama kids were on life support with flu

Pediatric Critical Care Columnist · Jan 7, 2007

indigo girl, I really don't know that much about her. She came in while I was on my days off, and when I went back I was in a different area of the unit and wasn't really able to learn that much. From what I can gather, she didn't appear to have any underlying problems; she's never been admitted to our unit before and she's not a little kid, she's an adolescent. I might be able to shed some more light on her on Tuesday; I'm working a day shift on Monday and can try to find out about her differential and the DIC question too. But I don't think she was in DIC when she went on ECMO and now she's anticoagulated, so who knows... I'll also try to find out if they've ID'd the strain.

Last year we had a kid with many underlying problems (including a mitochondrial disorder) who developed septic shock from the flu. He came into hospital the middle of February and coded on Valentine's Day. We got him back and kept him "going" until March 3. He had infarcted his bowel and was again in septic shock. At the insistence of his parents he went to the OR where he was opened and closed; half an hour after he returned to PICU he was taken off life support and died within seconds. It was heart-wrenching. He lived in my neighbourhood and I'm always fearful of running into his parents because I don't know what to say to them. He was their world. That's the worst part of working in PICU... helping parents say goodbye.

indigo girl · Jan 7, 2007

indigo girl, I really don't know that much about her. She came in while I was on my days off, and when I went back I was in a different area of the unit and wasn't really able to learn that much. From what I can gather, she didn't appear to have any underlying problems; she's never been admitted to our unit before and she's not a little kid, she's an adolescent. I might be able to shed some more light on her on Tuesday; I'm working a day shift on Monday and can try to find out about her differential and the DIC question too. But I don't think she was in DIC when she went on ECMO and now she's anticoagulated, so who knows... I'll also try to find out if they've ID'd the strain.
Last year we had a kid with many underlying problems (including a mitochondrial disorder) who developed septic shock from the flu. He came into hospital the middle of February and coded on Valentine's Day. We got him back and kept him "going" until March 3. He had infarcted his bowel and was again in septic shock. At the insistence of his parents he went to the OR where he was opened and closed; half an hour after he returned to PICU he was taken off life support and died within seconds. It was heart-wrenching. He lived in my neighbourhood and I'm always fearful of running into his parents because I don't know what to say to them. He was their world. That's the worst part of working in PICU... helping parents say goodbye.

I am so sorry to hear about this other child. I could never, never do the kind of work that you are doing, and I so admire all of you that do.

I find it interesting that the current case is an adolescent as this not the typical age group that usually has such a dire outcome with seasonal flu unless of course there is a prior existing condition.

Would it be correct to assume that this is an isolation case since it is influenza? Sorry to have so many questions, but what type of masks are being used to protect staff?

I would be very interested to hear from any other nurses in PICU if these type of cases come in. Same questions apply. This may be more common than I have been led to believe, but in healthy kids it does seem unusual.

Pediatric Critical Care Columnist · Jan 7, 2007

Our kiddie from last year, well we didn't mask as a rule with him. He was intubated the entire time he was with us; we use inline suction so the only time the circuit was open was if he needed really aggressive suctioning, then we wore regular isolation masks. Our droplet and contact precautions stipulate masks only when within one meter of the patient or if contact with infectious matter is anticipated. I can't remember anyone getting sick after working with him. I know they aren't routinely masking with our big girl right now either. It's odd that no one else in her family is ill.

We have a supply of N95 masks in a variety of sizes and are fit-tested every year to make sure we have protection. My face seems to change shape year-to-year, so I have to refer to the sticker the infection control people put on my ID card to make sure I have the right one! and of course it's not a "usual" size so they're not kept handy in the unit, but in a storage room. The alst kid I wore one for was a suspected TB, turned out to be plain old RSV, but an atypical presentation.

oramar · Jan 7, 2007

Our staffing levels are so tight that one ECMO patient strains us to the limit at times.

This is one scary statement. Your health service better start working some flexibility into the program.

Pediatric Critical Care Columnist · Jan 7, 2007

This is one scary statement. Your health service better start working some flexibility into the program.

Preaching to the choir, honey!! I've just fired off a long and detailed letter to our local union president. I'm thinking I should be going to the BON too...

indigo girl · Jan 8, 2007

Preaching to the choir, honey!! I've just fired off a long and detailed letter to our local union president. I'm thinking I should be going to the BON too...

You go, girl!

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BTW, here is another poor little kid from Florida, just 9 years old, my gosh:

http://www.sptimes.com/2007/01/05/Tampabay/Flu_blamed_for_death_.shtml

Unclear if any prior existing conditions. Maybe it depends on the viral loading dose at exposure. Which viral subtype is it?

indigo girl · Jan 8, 2007

Houston, we have a problem.

Speaking of Tamifu, the time between the onset of symptoms and the administration of the anti-viral is of prime importance in virulent influenza.

I just found out that Tamiflu treatment began within 24 hours of symptoms for the 15 year old that died in Egypt last month of H5N1...

The failure is not dose related. It has to do with the viral sequences, and what this particular strain has acquired presumably through recombination.

Now I understand the urgency to fund research into more antivirals like the parenteral one that the company in Birmingham is developing. They were given 1.2 million to help with this effort. Let us hope that they are successful.

Birmingham firm gets $1.2 million contract for bird flu treatment - Tuscaloosa

indigo girl · Jan 10, 2007

Another pediatric flu fatality, this time in NY, a ten year old, from influenza A with no mention of any prior existing conditions. I am guessing that this is an unusual case, but it's just a guess:

http://www.wgrz.com/news/news_article.aspx?storyid=43985

The health department has advised those who came in contact with the boy to see their doctors.

Pediatric Critical Care Columnist · Jan 10, 2007

Indigo girl, I tried to find out more about our teenager as promised, but the unit was desperately short staffed, I was covering breaks for two other patients and admitting a post-op cardiac patient who came out at 1000, and the bedside nurse for the patient in question didn't know anything. About anything. I can tell you that she was successfully decannulated on Saturday and extubated on Sunday and seems to be well on her way to a full recovery. And she's no longer isolated. The attending in the unit on Monday is an ID specialist so I'm guessing she's no longer contagious. And I don't know if we ever did get the Tamiflu...

Our other ECLS patient (RSV) was also successfully decannulated on the weekend although he remains intubated. Once they drained his pleural and pericardial effusions, bingo he was better. Imagine!

As for your post about the newest fatality... how horrible!!

indigo girl · Jan 10, 2007

Indigo girl, I tried to find out more about our teenager as promised, but the unit was desperately short staffed, I was covering breaks for two other patients and admitting a post-op cardiac patient who came out at 1000, and the bedside nurse for the patient in question didn't know anything. About anything. I can tell you that she was successfully decannulated on Saturday and extubated on Sunday and seems to be well on her way to a full recovery. And she's no longer isolated. The attending in the unit on Monday is an ID specialist so I'm guessing she's no longer contagious. And I don't know if we ever did get the Tamiflu...
Our other ECLS patient (RSV) was also successfully decannulated on the weekend although he remains intubated. Once they drained his pleural and pericardial effusions, bingo he was better. Imagine!
As for your post about the newest fatality... how horrible!!

I appreciate that you got back to me about this. I am glad that both kids appear to be doing better.

cactus wren · Jan 10, 2007

I find this kinda interesting;

Authorities aren't releasing the boy's name.

The health department has advised those who came in contact with the boy to see their doctors.

Now we know where that wacky psychic went to. How can the contacts report if they don`t know the name?

Nothing to see here, move along....

gr8greens · Jan 10, 2007

I find this kinda interesting;
Authorities aren't releasing the boy's name.
The health department has advised those who came in contact with the boy to see their doctors.
Now we know where that wacky psychic went to. How can the contacts report if they don`t know the name?
Nothing to see here, move along....

I was thinking the same thing. We are all aware of HIPPA and the limits it places on people.....and as I was told in another forum....the local health dep't was handling the necessary contacts. That doesn't comfort me much. The child probably was in contact with more children the family is unaware of.