Suggested Algorithm in the Workup and Management of Suspected Severe Influenza Pneumonia in the Critical Care Unit - Flowchart
Suggested Algorithm in the Workup and Management of Suspected Severe Influenza Pneumonia in the Critical Care Unit - Flowchart Pneumonia, Viral Pneumonia, Viral
«Flowchart»

Suspected severe influenza: Diffuse pneumonitis, other critical illness

Suspected severe influenza: Diffuse pneumonitis, other critical illness

Suspected severe influenza: Diffuse pneumonitis, other critical illness

Continue oseltamivir for 10 days
D/C CAP antibiotics if no bacterial pathogen identified

Continue oseltamivir for 10 days
D/C CAP antibiotics if no bacterial pathogen identified

Continue oseltamivir for 10 days
D/C CAP antibiotics if no bacterial pathogen identified


D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified

D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified

D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified



Nasopharyngeal swab + tracheal aspirate for influenza PCR/culture
Oseltamivir 75 mg PO/ng bid, Rx CAP
Store sample for serology

Nasopharyngeal swab + tracheal aspirate for influenza PCR/culture
Oseltamivir 75 mg PO/ng bid, Rx CAP
Store sample for serology

Nasopharyngeal swab + tracheal aspirate for influenza PCR/culture
Oseltamivir 75 mg PO/ng bid, Rx CAP
Store sample for serology



Low probability case

Low probability case

Low probability

High probability case

High probability case

High probability

End

End

End

Weekly influenza PCR (tracheal or nasopharyngeal aspirate) until negative
PCR or negative culture
Weekly sputum bacterial cultures

Weekly influenza PCR (tracheal or nasopharyngeal aspirate) until negative
PCR or negative culture
Weekly sputum bacterial cultures

Weekly influenza PCR (tracheal or nasopharyngeal aspirate) until negative
PCR or negative culture
Weekly sputum bacterial cultures



D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified

D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified

D/C oseltamivir
Continue CAP antibiotics for 7 to 14 days
Convalescent (28 day) influenza serology if no other pathogen identified



CAP, Community-acquired pneumonia; D/C, discontinue; PCR, polymerase chain reaction; PO, by mouth; Rx, prescription.

CAP, Community-acquired pneumonia; D/C, discontinue; PCR, polymerase chain reaction; PO, by mouth; Rx, prescription.

CAP, Community-acquired pneumonia; D/C, discontinue; PCR, polymerase chain reaction; PO, by mouth; Rx, prescription.

CAP D/C PCR PO Rx

PCR–

PCR–

PCR–

PCR+

PCR+

PCR+

PCR+

PCR+

PCR+

PCR–

PCR–

PCR–

Repeat nasopharyngeal + tracheal aspirate (if intubated)

Repeat nasopharyngeal + tracheal aspirate (if intubated)

Repeat nasopharyngeal + tracheal aspirate (if intubated)

PCR+

PCR+

PCR+

PCR–

PCR–

PCR–