Severe viral pneumonia in ICU: influenza, COVID-19, RSV

Also known as Influenza pneumonia · COVID-19 · RSV pneumonia · Viral ARDS · Severe viral respiratory infection

Severe viral pneumonia requiring ICU: INFLUENZA (seasonal A/H1N1/H3N2, pandemic H1N1pdm09, avian H5N1), COVID-19 (SARS-CoV-2), RSV (respiratory syncytial virus), ADENOVIRUS, CMV (immunocompromised), MEASLES, HANTAVIRUS (cardiopulmonary syndrome). Common features: viral ARDS, high oxygen requirement, lymphopenia, secondary bacterial/fungal infection. COVID-19 specific: hypercoagulability (VTE), multisystem inflammation (MIS), cytokine storm. Diagnosis: multiplex respiratory PCR panel; viral vs bacterial differentiation with procalcitonin (low in viral), CRP. Treatment: SUPPORTIVE (oxygen, lung-protective ventilation, prone positioning), ANTIVIRALS (oseltamivir/zanamivir for influenza within 48h; remdesivir for COVID-19; ribavirin for RSV in transplant), IMMUNOMODULATORS (dexamethasone, tocilizumab, baricitinib for COVID-19). Infection prevention: airborne/droplet isolation, PPE. Antiviral resistance (oseltamivir H275Y). Secondary infection (bacterial/fungal — CAPA aspergillosis, staphylococcal) common — monitor.

high33 referencesUpdated 20 Aug 20265 min readVerification in progress

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A 54-year-old presents in winter after four days of fever, myalgia, and dry cough. He now needs high-flow oxygen, has bilateral infiltrates and lymphopenia, and his partner has influenza. Six days later, after initial improvement, fever returns with purulent secretions and a new cavitating opacity.^[5]^[9]^[16]

This is two problems on one timeline: the virus that injured the lung, then the organism that exploited it. In viral pneumonia, day of illness and direction of travel are diagnostic data.^[9]^[16]

References33Show

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