Successful use of extracorporeal membrane oxygenation in a human immunodeficiency virus infected patient with severe acute respiratory distress syndrome

Abstract

IntroductionWe report a case of an adult patient with human immunodeficiency virus (HIV), acute respiratory distress syndrome (ARDS) and ventilator associated pneumonia (VAP) caused by multidrug resistant (MDR) bacteria that was successfully managed with veno-venous extracorporeal membrane oxygenation (ECMO).Case reportA 25 year old male with no significant past medical history had been admitted to a local hospital due to dyspnea and fever. His pulmonary function subsequently failed necessitating mechanical ventilation (MV) and introduction of ECMO support. The patient was transported for 300 km by road on ECMO to a tertiary medical center. The diagnosis of ARDS, HIV infection and MDR bacterial and fungal VAP was made. Patient was successfully treated with antiretroviral therapy (ART), anti-infective agents and 58 days of veno-venous ECMO support, with complete resolution of the respiratory symptoms.ConclusionHIV infected patients with ARDS and MDR bacterial VAP whose HIV replication is controlled by ART could be successfully managed with ECMO.

The use of extracorporeal membrane oxygenation in human immunodeficiency virus–positive patients: a review of a multicenter database

“…Several case reports and small series describe the use of ECMO in patients with HIV and respiratory failure. [3][4][5][6][7][8][9][10][11][12][13][14][15] The bias toward reporting successful cases is evident in the 93% survival of the 14 patients reported in these studies. In another study, Capatos et al 16 describe an aggressive approach to the management and cannulation of HIV patients with severe respiratory failure within three institutions in South Africa, with the authors reporting a survival to discharge among their 22 patients of 68% in all patients and 60% in those with Pneumocystis jirovecii pneumonia (PJP).…”

The use of extracorporeal membrane oxygenation in HIV-positive patients with severe respiratory failure: a retrospective observational case series

“…In the peer-reviewed literature there are a total of ten case descriptions of patients with HIV receiving VV ECMO, with eight survivors. 20,31–37 Of note, seven of the cases were for PJP-associated respiratory failure. Most recently, a retrospective series of 22 patients in Africa reported survival to hospital discharge of 68%, and of 60% in the PJP-positive cohort.…”

Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno‐venous extracorporeal membrane oxygenation: a case report and literature review

“…The indications for ECMO remain controversial, especially in patients who are immunosuppressed or have non‐recoverable comorbidities. There are several reports of successful ECMO use for severe hypoxia in patients with HIV/AIDS 2, 3, 4, 5, 6, 7, 8, 9, 10. However, key therapeutic issues, such as mechanical ventilation (MV) settings, indications for ECMO, and the timing of antiretroviral therapy (ART), have not always been discussed in these reports.…”

“…There are several reports of successful ECMO use for severe hypoxia in patients with HIV/AIDS. [2][3][4][5][6][7][8][9][10] However, key therapeutic issues, such as mechanical ventilation (MV) settings, indications for ECMO, and the timing of antiretroviral therapy (ART), have not always been discussed in these reports. A case of acute respiratory distress syndrome in a patient with novel HIV/ AIDS, who was successfully treated with veno-venous (V-V) ECMO and discharged, is presented.…”