He turned blue & needed machine to breathe for him
He is one of first two H1N1 patients to use lung bypass machine

IT BEGAN with flu-like symptoms. But he soon developed high fever and shortness of breath. Within days, he was on the brink of death as his lungs were ravaged by the H1N1 virus.

It's thanks to a lung bypass machine that Mr Lee Kok Hen,  36, is alive today.

He was one of the first two people here with H1N1 who owe their lives to the extra-corporeal membrane oxygenation (Ecmo) machine.

Dr Lim Chong Hee, senior consultant and director of the heart and lung transplant programme at National Heart Centre, said a ventilator could not get enough oxygen Into Mr Lee's blood.

A chest  X-ray showed both of his lungs were inflamed and filled with fluid - they were no longer functioning.

Mechanical ventilation via intubation - where a flexible tube is inserted into the airway leading to the lungs - is often inadequate in H1N1 viral  pneumonia cases. The lungs are too congested to allow oxygen exchange.

Explained Dr Lim: "When you are on ventilation, we are putting oxygen into your lungs."

Dying
'We were putting oxygen into Mr Lee's lungs at 40 per cent oxygen, 60 per cent, even 100 per cent, but he still looked blue. We could not get oxygen into his blood. He was going to die."

The air that we breathe is 21 per cent oxygen.

The only way to save Mr Lee was to put him on an artificial lung, which would do the breathing for him and oxygenate his blood.

The machine takes over the lung function and adds oxygen to the blood, allowing the lungs to recover and medication to treat infection to take hold.

It worked.

Mr Lee was gillen Tamiflu while booked up to the Ecmo machine. After a weel. he had recovered enough for doctors to remove the machine. But he was still kept on a ventilator, which was removed after another week.

He was discharged on 28 Aug after spending 17 days in the Singapore Genera! Hospital.

H1N1 flu can lead to viral pneumonia, which can result In severe respiratory failure in young adults.

Said Dr Lim: "Mr Lee is a prime example of this. He was well enough to walk into the hospital. Then he went downhill so suddenly, turned breathless and would have died."

Other types of pneumonia rarely progress so fast and so severely.

"Usually, when patients have such severe pneumonia, they also have multi·organ failure and cannot be put on Ecmo. They are also generally not young.

"H1N1 is peculiar in that it is young people who get such problems," said Dr Lim.

Many such patients in other countries hit by an earlier wave of H1N1 had been put on Ecmo to save them.

Said Dr Lim: "Countries such as the UK and the US reported about 50 per cent survival rates for H1N1 patients on Ecmo. Australia has reported 80 per cent survival rates.

"We don't know what our survival rates are yet as we have not had enough cases and we have not done a study. But if a second wave of H1N1I comes, we will have to consider Ecmo as a treatment option."

Mr Lee remembers little of his ordeal in hospital as he was sedated most of the time.

The security guard, who works the night, said he had a fever and went to a GP in early August.

"My fever was 39.2 deg C to 39.4 deg C. The GP gave me a three-day MC. But after that I still had the fever. So I went to the A&E at SGH and got a four-day MC," he told The New Paper.

Still  feeling unwell, he went back to the A&E and was hospitalised. Within 24 hours, he was close to dying.

"I could not separate between reality and dreams after I woke up. I felt rather out of it," said the bachelor. I just remember feeling really, really unwell, then a lot of bad dreams."

His mother filled him in on some details.

He says he's still not 100 per cent fit.

"Before H1N1, I cycled to work every day. I can't do that now. My lungs have not completely recovered. I still get breathless, especially when I'm climbing the stairs," he said.

His hospital bill, including the Ecmo treatment, came up to about $11,000.

"I'm worried about how I'm going to pay it off. But I'm also  very glad to be alive," he said.

The other H1N1 patient who was on Ecmo is a woman in her 20s who is still being treated at National University Hospital.

UK patient flown to Sweden for Ecmo treatment

A PREGNANT woman critically ill with H1N1 flu was flown from Scotland to a hospital in Sweden to save her life.

Ms Sharon Pentlelon, 26, suffered a severe reaction to the H1N1 virus, which left her lungs badly affected.

Like Mr Lee Kok Heng, she was put on extra-corporeal membrane oxygenation (Ecmo).

Ms Pentleton. who has a 2-year-old daughter, was flown to Sweden In late July because only one unit in the UK provides the Emco service - Glenfield hospital in Leicester - and its five beds were full,  two with H1N1 flu victims.

The UK Department of Health said the treatment was highly specialised and provision was limited across Europe. Countries regularly exchanged patients to make full use of the resources.

UK researchers said H1N1l flu could overwhelm intensive care beds this winter. Experts in intensive care and anaesthesia from the University of Cambridge, the Intensive Care Society and St George's Healthcare NHS Trust in London warned that UK hospitals might be unable to cope.

Ms Pentleton, who is seven months' pregnant, woke from a coma to discover she was wired up to life-support machines - and the medical staff were "talking strange".