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01.12.2014 | Case report | Ausgabe 1/2014 Open Access

BMC Anesthesiology 1/2014

Extra Corporeal Membrane Oxygenation (ECMO) in three HIV-positive patients with acute respiratory distress syndrome

Zeitschrift:
BMC Anesthesiology > Ausgabe 1/2014
Autoren:
Francesco Giuseppe De Rosa, Vito Fanelli, Silvia Corcione, Rosario Urbino, Chiara Bonetto, Davide Ricci, Mauro Rinaldi, Giovanni Di Perri, Stefano Bonora, Marco V Ranieri
Wichtige Hinweise
Francesco Giuseppe De Rosa, Vito Fanelli contributed equally to this work.

Competing interests

The authors declare that they have no competing interests and no specific funding was received.

Authors’ contributions

FDR, VF and VMR contributed to study design, data collection, drafting and writing the manuscript, including revision. SC contributed to data collection and drafting the manuscript. SB, GDP, RU, CB, DR and MR contributed to study design, supervision and critical revision of the manuscript for intellectual content. All authors read and approved the final manuscript. FDR and VF equally contributed to this work.

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is a life-saving bridging procedure in patients with severe acute respiratory distress syndrome (ARDS). Official indications for ECMO are unclear for immunocompromised and HIV-positive patients affected by severe hypoxemia. Uncertainties are related to prognosis and efficacy of treatment of the underlying disease. However, the care of patients with HIV infection has advanced since the introduction of highly active antiretroviral therapy (HAART), with increased life expectancy and decreased mortality.

Case presentation

Three HIV-infected patients with AIDS were admitted to ICU and were treated with ECMO: a 21 years old Caucasian female with congenital HIV infection presented with Pneumocystis jirovecii pneumonia (PJP); a 38 years old Caucasian female with HIV-HCV infection and L. pneumophila pneumonia; a 24 years old Caucasian male with fever, cough weight loss and PJP pneumonia. Two patients were alive, with a good immunovirological profile and they went back to their previous quality of life. The last patient died with septic shock after three months of ICU stay.

Conclusion

ECMO was effective in three HIV-positive patients with an otherwise fatal respiratory failure. All patients had severe immunosuppression and/or limited antiretroviral options. A multidisciplinary critical team is needed to individualize the use of ECMO in immunocompromised patients, including those with HIV infection.
Literatur
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