Scherer Clemens, Lüsebrink Enzo, Binzenhöfer Leonhard, Stocker Thomas J, Kupka Danny, Chung Hieu Phan, Stambollxhiu Era, Alemic Ahmed, Kellnar Antonia, Deseive Simon, Stark Konstantin, Petzold Tobias, Hagl Christian, Hausleiter Jörg, Massberg Steffen, Orban Martin
Department of Medicine I, University Hospital, LMU Munich, 81377 Munich, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 81377 Munich, Germany.
J Clin Med. 2022 Apr 22;11(9):2351. doi: 10.3390/jcm11092351.
(1) Herpes simplex virus (HSV) reactivation in critically ill patients can cause infection in the lower respiratory tract, prolonging mechanical ventilation. However, the association of HSV reactivation with cardiogenic shock (CS) is unclear. As CS is often accompanied by pulmonary congestion and reduced immune system activity, the aim of our study was to determine the incidence and outcome of HSV reactivation in these patients. (2) In this retrospective, single-center study, bronchial lavage (BL) was performed on 181 out of 837 CS patients with mechanical ventilation. (3) In 44 of those patients, HSV was detected with a median time interval of 11 days since intubation. The occurrence of HSV was associated with an increase in C-reactive protein and the fraction of inspired oxygen at the time of HSV detection. Arterial hypertension, bilirubin on ICU admission, the duration of mechanical ventilation and out-of-hospital cardiac arrest were associated with HSV reactivation. (4) HSV reactivation could be detected in 24.3% of patients with CS on whom BL was performed, and its occurrence should be considered in patients with prolonged mechanical ventilation. Due to the limited current evidence, the initiation of treatment for these patients remains an individual choice. Dedicated randomized studies are necessary to investigate the efficacy of antiviral therapy.
（1）重症患者单纯疱疹病毒（HSV）再激活可导致下呼吸道感染，延长机械通气时间。然而，HSV再激活与心源性休克（CS）之间的关联尚不清楚。由于CS常伴有肺淤血和免疫系统活性降低，我们研究的目的是确定这些患者中HSV再激活的发生率及转归。（2）在这项回顾性单中心研究中，对837例接受机械通气的CS患者中的181例进行了支气管灌洗（BL）。（3）在其中44例患者中检测到HSV，自插管以来的中位时间间隔为11天。HSV的出现与HSV检测时C反应蛋白和吸入氧分数的增加有关。动脉高血压、入住重症监护病房（ICU）时的胆红素水平、机械通气时间和院外心脏骤停与HSV再激活有关。（4）在接受BL的CS患者中，24.3%可检测到HSV再激活，对于机械通气时间延长的患者应考虑其发生情况。由于目前证据有限，对这些患者开始治疗仍属个人选择。需要开展专门的随机研究来调查抗病毒治疗的疗效。
