Lacerda Pereira Sara, Branco Elsa, Faustino Ana Sofia, Figueiredo Paulo, Sarmento António, Santos Lurdes
Centro Hospitalar e Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
Infect Dis Rep. 2021 Dec 2;13(4):1009-1017. doi: 10.3390/idr13040092.
Despite the undeniable complexity one may encounter while managing critically ill patients with human immunodeficiency virus infection (HIV), intensive care unit-related mortality has declined in recent years, not only because of more efficacious antiretroviral therapy (ART) but also due to the advances in critical support. However, the use of extracorporeal membrane oxygenation (ECMO) in these patients remains controversial. We report four cases of HIV-infected patients with pneumonia (PJP) and acute respiratory distress syndrome (ARDS) treated with ECMO support and discuss its indications and possible role in the prevention of barotrauma and ventilator- induced lung injury (VILI). The eventually favorable clinical course of the patients that we present suggests that although immune status is an important aspect in the decision to initiate ECMO support, this technology can provide real benefit in some patients with severe HIV-related refractory ARDS.
尽管在管理感染人类免疫缺陷病毒（HIV）的重症患者时可能会遇到不可否认的复杂性，但近年来重症监护病房相关的死亡率有所下降，这不仅是因为更有效的抗逆转录病毒疗法（ART），还得益于重症支持方面的进展。然而，在这些患者中使用体外膜肺氧合（ECMO）仍存在争议。我们报告了4例接受ECMO支持治疗的HIV感染合并肺炎（肺孢子菌肺炎）和急性呼吸窘迫综合征（ARDS）的患者，并讨论了其适应证以及在预防气压伤和呼吸机诱导性肺损伤（VILI）方面的可能作用。我们所呈现的患者最终良好的临床病程表明，尽管免疫状态是决定启动ECMO支持的一个重要因素，但这项技术在一些患有严重HIV相关难治性ARDS的患者中可带来实际益处。
