Jiao Yan-Na, Meng Jian-Biao
Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, PR China.
Department of Critical Care Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, PR China.
Medicine (Baltimore). 2025 May 23;104(21):e42092. doi: 10.1097/MD.0000000000042092.
Community-acquired pneumonia due to Acinetobacter baumannii (CAP-AB) is uncommon; however, its mortality is extremely high because of severe pneumonia, septic shock, and multiple organ dysfunction syndrome including septic cardiomyopathy and cardiogenic shock. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO), an important component of treatment in the early stage of septic cardiomyopathy can affect the prognosis of similar patients.
A 65-year-old man presented to the fever clinic with fever, cough, and stuffiness for 1 day. On admission, he manifested hypoxemia and hypotension, and chest computed tomography showed pneumonia, and Acinetobacter baumannii (AB) was positive in bronchoalveolar lavage fluid tested by metagenomic next-generation sequencing (mNGS).
Community-acquired pneumonia (CAP), respiratory failure, septic shock, septic cardiomyopathy, and cardiogenic shock.
As the diagnosis of septic shock, septic cardiomyopathy and cardiogenic shock induced by CAP-AB and respiratory failure were made, cefoperazone/sulbactam 3 g q8h, moxifloxacin 400 mg qd, inotropes and vasopressors and mechanical ventilation were initiated. However, although global end diastolic volume index was 744 mL/m2, hypotension and tachycardia remained, the left ventricular ejection fraction was 30%, and circulatory failure (cardiogenic shock) did not improve. Hence, VA-ECMO was applied to assist circulation on the day of admission due to the involvement of septic cardiomyopathy and cardiogenic shock.
On day 2, tachycardia improved, left ventricular ejection fraction increased to 54%, and VA-ECMO was withdrawn on day 5. On day 10, mechanical ventilation was withdrawn and the tracheal cannula was removed. Subsequently, the patient was transferred to the respiratory department on day 14.
A patient with septic cardiomyopathy and cardiogenic shock induced by severe CAP-AB was treated with VA-ECMO in the early stage. Patients with CAP-induced septic cardiomyopathy may benefit from the introduction of VA-ECMO during the early stage. Further studies are required to evaluate the advantages and disadvantages of early VA-ECMO in patients with CAP-induced septic cardiomyopathy.
鲍曼不动杆菌引起的社区获得性肺炎（CAP-AB）并不常见；然而，由于严重肺炎、感染性休克和包括感染性心肌病及心源性休克在内的多器官功能障碍综合征，其死亡率极高。静脉-动脉体外膜肺氧合（VA-ECMO）是感染性心肌病早期治疗的重要组成部分，可影响类似患者的预后。
一名65岁男性因发热、咳嗽、鼻塞1天就诊于发热门诊。入院时，他表现为低氧血症和低血压，胸部计算机断层扫描显示肺炎，经宏基因组下一代测序（mNGS）检测，支气管肺泡灌洗液中鲍曼不动杆菌（AB）呈阳性。
社区获得性肺炎（CAP）、呼吸衰竭、感染性休克、感染性心肌病、心源性休克。
由于诊断为CAP-AB引起的感染性休克、感染性心肌病和心源性休克以及呼吸衰竭，开始使用头孢哌酮/舒巴坦3g每8小时一次、莫西沙星400mg每日一次，使用血管活性药物和血管加压药并进行机械通气。然而，尽管全心舒张末期容积指数为744mL/m²，但低血压和心动过速仍持续存在，左心室射血分数为30%，循环衰竭（心源性休克）未改善。因此，由于感染性心肌病和心源性休克的影响，在入院当天应用VA-ECMO辅助循环。
第2天，心动过速改善，左心室射血分数增至54%，第5天停用VA-ECMO。第10天，撤机并拔除气管插管。随后，患者于第14天转至呼吸科。
一名由严重CAP-AB引起的感染性心肌病和心源性休克患者在早期接受了VA-ECMO治疗。CAP引起的感染性心肌病患者在早期引入VA-ECMO可能会受益。需要进一步研究来评估早期VA-ECMO在CAP引起的感染性心肌病患者中的利弊。
