It is recommended that patients with pandemic H1N1 influenza A who develop pneumonia be treated empirically for CAP according to published evidence-based guidelines, given the risk of secondary bacterial pneumonia [73] . In the presence of profound hypoxemia that has been refractory to routine mechanical ventilation, salvage therapies include neuromuscular blockade, inhaled nitric oxide, high-frequency oscillatory ventilation, extracorporeal membrane oxygenation (ECMO), and prone positioning ventilation [74•, 75] . Corticosteroids should not be used routinely, but may be considered for septic shock with suspected adrenal insufficiency requiring vasopressors [76] . Therapy for influenza-associated ARDS should be based upon published evidence-based guidelines for sepsis-associated ARDS, specifically including lung protective mechanical ventilation strategies [76] .