Saito Kenki, Aokage Toshiyuki, Sato Takayuki, Tsukahara Kohei, Tokioka Fumiaki, Otake Takanao, Irie Hiromasa, Ueda Yasunori
Department of Hematology/Oncology, Kurashiki Central Hospital, Japan.
Department of Geriatric Emergency Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Respir Med Case Rep. 2020 Sep 14;31:101224. doi: 10.1016/j.rmcr.2020.101224. eCollection 2020.
() is a Gram-negative, multidrug-resistant organism that both opportunistically infects the bloodstream and leads to pneumonia in immunosuppressed patients, including those with hematologic malignancies. In patients with severe respiratory failure, venovenous extracorporeal membrane oxygenation (VV ECMO) can stabilize the respiratory status. However, whether ECMO in patients with hematologic malignancies improves the clinical outcomes is still controversial because ECMO increases the risk of the exacerbation of sepsis and bleeding. We report a case of a 46-year-old man with hemorrhagic pneumonia acquired during consolidation chemotherapy for acute myeloid leukemia in whom VV ECMO lead to a good clinical outcome. The stabilization of his respiratory status achieved with VV ECMO allowed time for trimethoprim-sulfamethoxazole antibiotic therapy to improve the pneumonia. We suggest the background of patients, including comorbidities and general conditions, should be taken into account when considering the clinical indications of ECMO.
（某病原体）是一种革兰氏阴性、多重耐药菌，它既会机会性地感染血液，又会导致包括血液系统恶性肿瘤患者在内的免疫抑制患者发生肺炎。在严重呼吸衰竭患者中，静脉-静脉体外膜肺氧合（VV ECMO）可稳定呼吸状态。然而，血液系统恶性肿瘤患者使用ECMO是否能改善临床结局仍存在争议，因为ECMO会增加脓毒症加重和出血的风险。我们报告一例46岁男性病例，该患者在急性髓系白血病巩固化疗期间罹患出血性肺炎，VV ECMO治疗使其获得了良好的临床结局。VV ECMO实现的呼吸状态稳定为复方新诺明抗生素治疗改善肺炎争取了时间。我们建议，在考虑ECMO的临床适应证时，应考虑患者的背景情况，包括合并症和一般状况。
