Severe Influenza Checklist Diagnostic tests - Blood cultures x2 - Sputum gram stain & culture - Urine legionella & pneumococcal antigens - Nares PCR for MRSA - Procalcitonin - Ferritin, liver function tests - Ultrasound if needed to exclude effusion - CT scan if diagnostic uncertainty (e.g. vs PE or opportunistic infection). Resuscitation & respiratory support - Fluid conservative resuscitation — DO NOT bolus 30 cc/kg fluid. - Consider early high-flow nasal cannula for dyspnea/tachypnea. Antibiotics - Oseltamavir 75 mg BID (or IV peramivir if NPO) - Clarithromycin 500 mg BID (azithromycin if clarithromycin unavailable or fiQT) - Beta-lactam until bacterial pneumonia excluded (ceftriaxone, piptazo, or cefepime) - Linezolid 600 mg PO/IV q 1 2hr if post-flu MRSÅ pneumonia suspected Adiunctive treatments - Steroid only if other indication (e.g. COPD/asthma or adrenal insufficiency). - May consider ascorbic acid 1.5 grams IV q6hr & thiamine 200 mg IV ql 2hr - May consider naproxen —200 mg BID if <96hr of symptoms, lab-confirmed influenza, pulmonary infiltrates, and GFR > 30 ml/min without AKI Dr. Josh Farkas @PulmCrit #Influenza #Checklist #Management #CriticalCare
