1 Department of Emergency and Intensive Care Medicine, Centro Hospitalar S.João, Porto, Portugal.
2 Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal.
J Intensive Care Med. 2019 Apr;34(4):344-350. doi: 10.1177/0885066617700121. Epub 2017 Mar 23.
: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center.
: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016.
: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia.
: Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao/Fio ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to "lung rest" settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmHO) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13).
: In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.
分析本中心使用体外膜氧合（ECMO）抢救难治性呼吸衰竭合并重症军团菌肺炎患者的管理和结局。
2009 年 11 月至 2016 年 9 月，对葡萄牙波尔图圣若昂医院（Hospital S.João）使用 ECMO 抢救的难治性呼吸衰竭患者进行观察性研究。
共 112 例患者接受 ECMO 抢救，其中 14 例患有军团菌肺炎。
军团菌肺炎患者比其他病因引起的急性呼吸衰竭患者稍年长（51 [48-56] vs 45 [35-54]），但两组急性呼吸衰竭严重程度无显著差异：氧合指数（Pao/Fio2）67（60-75）与 69（55-85）和呼吸体外膜氧合生存预测评分（Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score，RESP）4（1-5）与 2（-1-4）。军团菌肺炎患者 ECMO 启动时间更早（ECMO 前有创机械通气[invasive mechanical ventilation，IMV]天数：2.0[1.0-4.0] vs 5.0[2.0-9.5]）。在将 IMV 调整至“肺休息”设置后，该组患者的呼吸系统（respiratory system，RS）静态顺应性更高（28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O），但需要更高的 ECMO 支持（血流 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]）。军团菌肺炎患者的 IMV 时间更短（16 [14-23] vs 27 [20-42] 天），重症监护病房医院获得性感染发生率更低（35.7% vs 64.3%），且住院生存率更高（85.7% vs 62.2%；P =.13）。
在难治性呼吸衰竭合并军团菌肺炎中，ECMO 支持可在保护性通气下稳定患者，并获得较高的生存率。对于常规治疗失败的军团菌肺炎，应及时考虑 ECMO 转介。
