Horikita Sho, Sanui Masamitsu, Fujimoto Yuki, Lefor Alan Kawarai
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan.
Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
BMJ Case Rep. 2017 Jun 28;2017:bcr-2017-219870. doi: 10.1136/bcr-2017-219870.
Veno-venous extracorporeal membrane oxygenation (ECMO) is being more commonly used in patients with acute respiratory distress syndrome (ARDS) due to potentially reversible illnesses. Survival from ARDS using ECMO has been reported even in patients with AIDS. However, the indications for ECMO for ARDS due to immune reconstitution inflammatory syndrome (IRIS) in patients with AIDS are unknown. A 23-year-old man with AIDS and pneumonia was admitted to the intensive care unit with severe ARDS refractory to mechanical ventilator support requiring ECMO. Although ECMO was discontinued, a second treatment with ECMO was necessary due to IRIS-associated ARDS, resulting in an excellent patient outcome. This patient's clinical course suggests two important messages. First, ECMO is a reasonable option for the treatment of patients with ARDS even in a patient with AIDS. Second, ECMO may be effective for the treatment of patients with IRIS.
静脉-静脉体外膜肺氧合（ECMO）在因潜在可逆性疾病导致急性呼吸窘迫综合征（ARDS）的患者中使用得越来越普遍。即使是艾滋病患者，使用ECMO治疗ARDS也有存活的报道。然而，艾滋病患者因免疫重建炎症综合征（IRIS）导致ARDS时ECMO的应用指征尚不清楚。一名患有艾滋病和肺炎的23岁男性因严重ARDS入住重症监护病房，对机械通气支持无效，需要ECMO治疗。尽管ECMO停用了，但由于IRIS相关的ARDS，需要再次进行ECMO治疗，患者最终预后良好。该患者的临床病程提示了两条重要信息。第一，即使是艾滋病患者，ECMO也是治疗ARDS患者的合理选择。第二，ECMO可能对IRIS患者有效。
