Chen Xuefei, Lv Jianhai, Qin Lu, Zou Chaochun, Tang Lanfang
Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Front Pediatr. 2020 Apr 15;8:162. doi: 10.3389/fped.2020.00162. eCollection 2020.
To highlight severe adenovirus pneumonia in immunocompetent patients by analysis of severe adenovirus pneumonia associated with acute respiratory distress syndrome in whom extracorporeal membrane oxygenation (ECMO) support is required. Pediatric patients with adenovirus pneumonia and ECMO supports in our hospital from February 2018 to May 2019 were retrospectively analyzed, and having 100 common adenovirus pneumonia children as a control. A total of 8 patients, including 4 boys (50.0%), were enrolled. They were previously immunocompetent with a median age of 31 months. They were admitted as persistent fever and cough for more than one week. Median time prior to development of respiratory failure requiring intubation and invasive mechanical ventilation was 5 days. Venoarterial ECMO support as rescue ventilation was instituted after a median time of 24.5 h of conventional mechanical ventilator support. The median duration on ECMO support was 9 days and mechanical ventilation was 14 days, respectively. Six patients (75%) were recovered and 2 (25%) died. Median length of stay in ICU and hospital were 27.5 days and 47.5 days, respectively. The promising outcomes of our cases suggested that ECMO support for rescue ventilation may be considered when symptoms deteriorated in adenovirus pneumonia patients, and may improve outcome. However, sequelae of adenovirus pneumonia and ECMO-related complications should also be taken into account.
通过分析需要体外膜肺氧合（ECMO）支持的与急性呼吸窘迫综合征相关的重症腺病毒肺炎，以凸显免疫功能正常患者中的重症腺病毒肺炎。回顾性分析了2018年2月至2019年5月在我院接受ECMO支持的腺病毒肺炎儿科患者，并将100例普通腺病毒肺炎儿童作为对照。共纳入8例患者，其中4例为男孩（50.0%）。他们之前免疫功能正常，中位年龄为31个月。他们因持续发热和咳嗽超过一周入院。发生呼吸衰竭需要插管和有创机械通气之前的中位时间为5天。在常规机械通气支持中位时间24.5小时后，开始采用静脉-动脉ECMO支持作为抢救通气。ECMO支持的中位持续时间分别为9天，机械通气为14天。6例患者（75%）康复，2例（25%）死亡。在重症监护病房（ICU）和医院的中位住院时间分别为27.5天和47.5天。我们病例的良好结果表明，当腺病毒肺炎患者症状恶化时，可考虑采用ECMO支持进行抢救通气，这可能改善预后。然而，也应考虑腺病毒肺炎的后遗症和与ECMO相关的并发症。
