Pulsipher Aaron M, Henry Kyle, Vikram Holenarasipur R, Gotway Michael B, Cartin-Ceba Rodrigo, Limper Andrew H, Lee Augustine, Patel Bhavesh, Miller Brittany, Thompson Emily R, Sen Ayan, Ham Kealy
Department of Critical Care, Mayo Clinic, Phoenix, AZ.
Division of Infectious Diseases and Transplant Center, Mayo Clinic, Phoenix, AZ.
Crit Care Explor. 2025 Aug 4;7(8):e1296. doi: 10.1097/CCE.0000000000001296. eCollection 2025 Aug 1.
Pneumocystis jirovecii pneumonia (PCP) is a life-threatening opportunistic infection increasingly recognized among non-HIV immunocompromised patients. In severe cases progressing to acute respiratory distress syndrome, venovenous extracorporeal membrane oxygenation (VV-ECMO) may serve as a rescue therapy. We conducted a retrospective multicenter review of 10 adult patients with proven or probable PCP who received VV-ECMO between 2017 and 2024. Seven of 10 patients survived to discharge, including all three HIV-positive patients and 4 of 7 non-HIV immunocompromised patients. The mean Respiratory ECMO Survival Prediction Score was -1.5, corresponding to a predicted survival of 33-57%. Multiorgan dysfunction was common, including renal failure requiring dialysis in 6 of 10 patients, need for neuromuscular blockade in 8 of 10, and pulmonary vasodilator use in 8 of 10. Despite high acuity and prolonged ECMO support, outcomes were favorable. These findings suggest that VV-ECMO may be a viable salvage therapy for select patients with severe PCP, including those without HIV.
耶氏肺孢子菌肺炎（PCP）是一种危及生命的机会性感染，在非HIV免疫功能低下患者中越来越受到认可。在进展为急性呼吸窘迫综合征的严重病例中，静脉-静脉体外膜肺氧合（VV-ECMO）可作为一种挽救治疗方法。我们对2017年至2024年间接受VV-ECMO治疗的10例确诊或疑似PCP的成年患者进行了一项回顾性多中心研究。10例患者中有7例存活出院，包括所有3例HIV阳性患者和7例非HIV免疫功能低下患者中的4例。呼吸ECMO生存预测评分的平均值为-1.5，对应的预测生存率为33%-57%。多器官功能障碍很常见，10例患者中有6例出现需要透析的肾衰竭，10例中有8例需要神经肌肉阻滞，10例中有8例使用肺血管扩张剂。尽管病情严重且ECMO支持时间延长，但预后良好。这些发现表明，VV-ECMO可能是包括非HIV患者在内的某些严重PCP患者可行的挽救治疗方法。
