Obata Reiichiro, Azuma Kazunari, Nakamura Itaru, Oda Jun
Department of Emergency and Critical Care Medicine Tokyo Medical University Shinjuku Japan.
Department of Infection Prevention and Control Tokyo Medical University Shinjuku Japan.
Acute Med Surg. 2018 Aug 19;5(4):384-389. doi: 10.1002/ams2.364. eCollection 2018 Oct.
Several successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed.A 47-year-old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO/FO ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made. Based on clinical indications, treatment for pneumonia and concomitant bacterial infection was started.
Despite broad-spectrum antibiotics, the patient's oxygenation deteriorated, necessitating ECMO. After 19 days of ECMO therapy, the patient was successfully decannulated and was eventually discharged.
In acute respiratory distress syndrome in patients with HIV/AIDS refractory to treatment, ECMO should be considered. Post-ECMO antiretroviral therapy could improve outcomes.
已有报道称，体外膜肺氧合（ECMO）在新型人类免疫缺陷病毒/获得性免疫综合征（HIV/AIDS）感染患者的急性呼吸窘迫综合征治疗中多次成功应用；然而，治疗关键因素并非总是得到讨论。一名47岁男性因进行性呼吸急促入院。他处于呼吸衰竭状态，动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）为110.8，需要进行插管。胸部计算机断层扫描显示弥漫性磨玻璃影。怀疑为HIV感染，并诊断为急性呼吸窘迫综合征。根据临床指征，开始针对肺炎及合并细菌感染进行治疗。
尽管使用了广谱抗生素，患者的氧合情况仍恶化，需要进行ECMO治疗。经过19天的ECMO治疗，患者成功拔管，最终出院。
对于治疗难治的HIV/AIDS患者的急性呼吸窘迫综合征，应考虑使用ECMO。ECMO治疗后的抗逆转录病毒疗法可能改善治疗结果。
