Low S Y, Tan T T, Lee C H K, Loo C M, Chew H C
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Respir Med. 2013 Nov;107(11):1810-3. doi: 10.1016/j.rmed.2013.09.008. Epub 2013 Sep 19.
Adenovirus causing severe fatal pneumonia has been well described in infants, children, and patients with immunocompromised function, but reports in previously healthy adults are rare. We report 3 cases of severe adenovirus pneumonia in whom conventional mechanical ventilation failed and required extracorporeal membrane oxygenation support.
Retrospective case records review of 3 patients admitted to the medical intensive care unit, Singapore General Hospital, a tertiary care university-affiliated hospital, with severe adenovirus pneumonia requiring extracorporeal membrane oxygenation support from February to March 2013.
All 3 patients were previously healthy immunocompetent adults from the community with negative HIV serology. Duration prior to development of respiratory failure requiring intubation and invasive mechanical ventilation was 2, 8 and 3 days. Veno-venous extracorporeal membrane oxygenation (ECMO) support as rescue ventilation was instituted in all 3 patients after 2, 16, and 5 days of conventional mechanical ventilator support. Duration on ECMO support was 16, 22, and 9 days and mechanical ventilation was 18, 62, and 19 days respectively. Length of stay in intensive care unit was 18, 68, and 21 days, and length of stay in hospital was 20, 70, and 31 days respectively. Two of the 3 patients died.
The mainstay of treatment for patients with severe adenovirus pneumonia is still supportive, with the use of antivirals not apparently effective. Whilst ECMO support for rescue ventilation may be considered, the outcomes do not appear as promising as other viral pneumonias, mirroring that previously described in the paediatric population.
腺病毒导致的严重致命性肺炎在婴儿、儿童及免疫功能低下的患者中已有充分描述，但此前健康的成年人中此类报告较为罕见。我们报告3例严重腺病毒肺炎患者，他们常规机械通气失败，需要体外膜肺氧合支持。
回顾性分析2013年2月至3月入住新加坡国立大学附属医院新加坡总医院医学重症监护病房的3例严重腺病毒肺炎患者的病例记录，这些患者需要体外膜肺氧合支持。
所有3例患者均为此前健康的社区免疫功能正常成年人，HIV血清学检测阴性。出现呼吸衰竭需要插管及有创机械通气之前的病程分别为2天、8天和3天。在常规机械通气支持2天、16天和5天后，所有3例患者均采用静脉-静脉体外膜肺氧合（ECMO）支持作为挽救性通气。ECMO支持时间分别为16天、22天和9天，机械通气时间分别为18天、62天和19天。重症监护病房住院时间分别为18天、68天和21天，住院时间分别为20天、70天和31天。3例患者中有2例死亡。
严重腺病毒肺炎患者的主要治疗方法仍然是支持治疗，抗病毒药物使用后效果不明显。虽然可考虑采用ECMO支持进行挽救性通气，但预后似乎不像其他病毒性肺炎那样乐观，这与此前儿科人群中的描述一致。
