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Brogan TV, Thiagarajan RR, Lorusso R, McMullan DM, Di Nardo M, Ogino MT, Dalton HJ, Burke CR, Capatos G. The use of extracorporeal membrane oxygenation in human immunodeficiency virus-positive patients: a review of a multicenter database. Perfusion 2020; 35:772-777. [PMID: 32141382 DOI: 10.1177/0267659120906966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM We chose to evaluate the survival of extracorporeal membrane oxygenation among patients with human immunodeficiency virus in a multicenter registry. METHODS Retrospective case review of the Extracorporeal Life Support Organization Registry respiratory failure of all patients with human immunodeficiency virus supported with extracorporeal membrane oxygenation. RESULTS A total of 126 patients were included. Survival to discharge was 36%. Eight infants were supported with extracorporeal membrane oxygenation and three (37.5%) survived to discharge. Respiratory extracorporeal membrane oxygenation was the primary indication (78%) with a 39% survival, while cardiac and extracorporeal cardiopulmonary resuscitation indications accounted for 16% and 6% of patients with survivals of 30% and 12.5%, respectively. These differences did not reach significance. There were no significant differences between survivors and non-survivors in demographic data, but non-survivors had significantly more non-human immunodeficiency virus pre-extracorporeal membrane oxygenation infections than survivors. There were no differences in other pre-extracorporeal membrane oxygenation supportive therapies, mechanical ventilator settings, or arterial blood gas results between survivors and non-survivors. The median duration of mechanical ventilation prior to cannulation was 52 (interquartile range: 13-140) hours, while the median duration of the extracorporeal membrane oxygenation exposure was 237 (interquartile range: 125-622) hours. Ventilator settings were significantly lower after 24 hours compared to pre-extracorporeal membrane oxygenation settings. Complications during extracorporeal membrane oxygenation exposure including receipt of renal replacement therapy, inotropic infusions, and cardiopulmonary resuscitation were more common among non-survivors compared to survivors. Central nervous system complications were rare. CONCLUSION Survival among patients with human immunodeficiency virus infection who receive extracorporeal membrane oxygenation was less than 40%. Infections before extracorporeal membrane oxygenation cannulation occurred more often in non-survivors. The receipt of renal replacement therapy, inotropic infusions, or cardiopulmonary resuscitation during extracorporeal membrane oxygenation was associated with worse outcome.
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Affiliation(s)
- Thomas V Brogan
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ravi R Thiagarajan
- Department of Cardiology, Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Roberto Lorusso
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - D Michael McMullan
- Division of Cardiothoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - Mark T Ogino
- Nemours/Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA
| | | | - Christopher R Burke
- Department of Thoracic Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Gerry Capatos
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates
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Obata R, Azuma K, Nakamura I, Oda J. Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno-venous extracorporeal membrane oxygenation: a case report and literature review. Acute Med Surg 2018; 5:384-389. [PMID: 30338087 PMCID: PMC6167405 DOI: 10.1002/ams2.364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/02/2018] [Indexed: 12/29/2022] Open
Abstract
Case Several successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed. A 47‐year‐old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO2/FIO2 ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made. Based on clinical indications, treatment for Pneumocystis jirovecii pneumonia and concomitant bacterial infection was started. Outcome Despite broad‐spectrum antibiotics, the patient's oxygenation deteriorated, necessitating ECMO. After 19 days of ECMO therapy, the patient was successfully decannulated and was eventually discharged. Conclusion In acute respiratory distress syndrome in patients with HIV/AIDS refractory to treatment, ECMO should be considered. Post‐ECMO antiretroviral therapy could improve outcomes.
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Affiliation(s)
- Reiichiro Obata
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku Japan
| | - Kazunari Azuma
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control Tokyo Medical University Shinjuku Japan
| | - Jun Oda
- Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku Japan
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Hernandez Conte AT, Ng D, Ramzy D, Dilibero D, LaBounty TM, Gaultier C, Behringer EC. Extracorporeal Membrane Oxygenation in a 29-Year-Old Man with Pneumocystis jirovecii Respiratory Failure and AIDS. Tex Heart Inst J 2018; 45:254-259. [PMID: 30374241 DOI: 10.14503/thij-16-6186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been generally beneficial. However, because of various concerns, ECMO has rarely been used in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. We report our successful use of venovenous ECMO in a 29-year-old man who presented with severe respiratory distress secondary to Pneumocystis jirovecii pneumonia associated with undiagnosed infection with the human immunodeficiency virus and acquired immune deficiency syndrome. After highly active antiretroviral therapy was begun, acute immune reconstitution inflammatory syndrome developed. The patient's respiratory condition deteriorated rapidly; he was placed on venovenous ECMO for 19 days and remained intubated thereafter. After a 65-day hospital stay and inpatient pulmonary rehabilitation, he recovered fully. In addition to presenting this case, we review the few previous reports and note the multidisciplinary medical and surgical support necessary to treat similar patients.
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Lee N, Lawrence D, Patel B, Ledot S. HIV-related Pneumocystis jirovecii pneumonia managed with caspofungin and veno-venous extracorporeal membrane oxygenation rescue therapy. BMJ Case Rep 2017; 2017:bcr-2017-221214. [PMID: 28978595 PMCID: PMC5652506 DOI: 10.1136/bcr-2017-221214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patients with pneumocystis pneumonia have a risk of progressing to acute respiratory failure necessitating admission to intensive care. The case described is of a patient with a newly diagnosed HIV infection presenting with pneumocystis pneumonia. Despite initiating the appropriate pharmacological treatment the patient’s clinical condition deteriorated, and required both rescue pharmacological therapy with echinocandins as well as respiratory support with extracorporeal membrane oxygenation therapy. The patient recovered well on ventilator and circulatory support despite a long weaning process complicated by sequelae common to pneumocystis pneumonia. Following initialisation of antiretroviral therapy and step-down from an intensive care setting, the patient required further prolonged hospital stay for rehabilitation and mental health support before being discharged. This case reviews the novel pharmacological therapies and respiratory support strategies used in cases of pneumocystis pneumonia, including the clinical and psychological sequelae that may follow.
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Affiliation(s)
- Nathaniel Lee
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Anaesthesia and Critical Care, London, UK
| | - David Lawrence
- The Lawson Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Brijesh Patel
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Anaesthesia and Critical Care, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Anaesthesia and Critical Care, London, UK
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Morley D, Lynam A, Carton E, Martin-Loeches I, Sheehan G, Lynn N, O'Brien S, Mulcahy F. Extracorporeal membrane oxygenation in an HIV-positive man with severe acute respiratory distress syndrome secondary to pneumocystis and cytomegalovirus pneumonia. Int J STD AIDS 2017; 29:198-202. [PMID: 28803505 DOI: 10.1177/0956462417725447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO. He was successfully decannulated following 21 days of ECMO and survived to hospital discharge. Despite poor evidence surrounding the use of ECMO in immunocompromised patients, it is evident that ECMO could represent an important rescue therapy in HIV-positive patients with refractory ARDS.
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Affiliation(s)
- Deirdre Morley
- 1 Department of Genito Urinary Medicine and Infectious Diseases, Saint James Hospital, Dublin, Ireland
| | - Almida Lynam
- 1 Department of Genito Urinary Medicine and Infectious Diseases, Saint James Hospital, Dublin, Ireland
| | - Edmund Carton
- 2 Department of Intensive Care Medicine, 8881 Mater Misericordiae Hospital , Dublin, Ireland
| | | | - Gerard Sheehan
- 4 Department of Infectious Diseases, Mater Misericordiae Hospital, Dublin, Ireland
| | - Niamh Lynn
- 1 Department of Genito Urinary Medicine and Infectious Diseases, Saint James Hospital, Dublin, Ireland
| | - Serena O'Brien
- 2 Department of Intensive Care Medicine, 8881 Mater Misericordiae Hospital , Dublin, Ireland
| | - Fiona Mulcahy
- 1 Department of Genito Urinary Medicine and Infectious Diseases, Saint James Hospital, Dublin, Ireland
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Ali HS, Hassan IF, George S. Extra corporeal membrane oxygenation to facilitate lung protective ventilation and prevent ventilator-induced lung injury in severe Pneumocystis pneumonia with pneumomediastinum: a case report and short literature review. BMC Pulm Med 2016; 16:52. [PMID: 27080997 PMCID: PMC4832462 DOI: 10.1186/s12890-016-0214-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/04/2016] [Indexed: 12/02/2022] Open
Abstract
Background Pulmonary infections caused by Pneumocystis jirovecii in immunocompromised host can be associated with cysts, pneumatoceles and air leaks that can progress to pneumomediastinum and pneumothoraxes. In such cases, it can be challenging to maintain adequate gas exchange by conventional mechanical ventilation and at the same time prevent further ventilator-induced lung injury. We report a young HIV positive male with poorly compliant lungs and pneumomediastinum secondary to severe Pneumocystis infection, rescued with veno-venous extra corporeal membrane oxygenation (V-V ECMO). Case presentation A 26 year old male with no significant past medical history was admitted with fever, cough and shortness of breath. He initially required non-invasive ventilation for respiratory failure. However, his respiratory function progressively deteriorated due to increasing pulmonary infiltrates and development of pneumomediastinum, eventually requiring endotracheal intubation and invasive ventilation. Despite attempts at optimizing gas exchange by ventilatory maneuvers, patients’ pulmonary parameters worsened necessitating rescue ECMO therapy. The introduction of V-V ECMO facilitated the use of ultra-protective lung ventilation and prevented progression of pneumomediastinum, maintaining optimal gas exchange. It allowed time for the antibiotics to show effect and pulmonary parenchyma to heal. Further diagnostic workup revealed Pneumocystis jirovecii as the causative organism for pneumonia and serology confirmed Human Immunodeficiency Virus infection. Patient was successfully treated with appropriate antimicrobials and de-cannulated after six days of ECMO support. Conclusion ECMO was an effective salvage therapy in HIV positive patient with an otherwise fatal respiratory failure due to Pneumocystis pneumonia and air leak syndrome.
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Affiliation(s)
- Husain Shabbir Ali
- Department of Medical ICU, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar, Qatar.
| | - Ibrahim Fawzy Hassan
- Department of Medical ICU, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar, Qatar
| | - Saibu George
- Department of Medical ICU, Hamad General Hospital, P.O. Box 3050, Doha, State of Qatar, Qatar
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Park DW, Lim DH, Kim B, Yhi JY, Moon JY, Kim SH, Kim TH, Shon JW, Yoon HJ, Shin DH, Pai H. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumocystis jiroveciiPneumonia: Case Report and Literature Review. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.31.2.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dong Won Park
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Dae Hyun Lim
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Ji Young Yhi
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Jang Won Shon
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Dong Ho Shin
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University Hospital, Seoul, Korea
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