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Open Access Case report

Extra Corporeal Membrane Oxygenation (ECMO) in three HIV-positive patients with acute respiratory distress syndrome

Francesco Giuseppe De Rosa1*, Vito Fanelli2, Silvia Corcione1, Rosario Urbino2, Chiara Bonetto2, Davide Ricci3, Mauro Rinaldi3, Giovanni Di Perri1, Stefano Bonora1 and Marco V Ranieri2

Author Affiliations

1 Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy

2 Department of Surgical Sciences, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy

3 Department of Surgical Sciences, Cardiosurgery Unit, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy

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BMC Anesthesiology 2014, 14:37  doi:10.1186/1471-2253-14-37

Published: 21 May 2014

Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is a life-saving bridging procedure in patients with severe acute respiratory distress syndrome (ARDS). Official indications for ECMO are unclear for immunocompromised and HIV-positive patients affected by severe hypoxemia. Uncertainties are related to prognosis and efficacy of treatment of the underlying disease. However, the care of patients with HIV infection has advanced since the introduction of highly active antiretroviral therapy (HAART), with increased life expectancy and decreased mortality.

Case presentation

Three HIV-infected patients with AIDS were admitted to ICU and were treated with ECMO: a 21 years old Caucasian female with congenital HIV infection presented with Pneumocystis jirovecii pneumonia (PJP); a 38 years old Caucasian female with HIV-HCV infection and L. pneumophila pneumonia; a 24 years old Caucasian male with fever, cough weight loss and PJP pneumonia. Two patients were alive, with a good immunovirological profile and they went back to their previous quality of life. The last patient died with septic shock after three months of ICU stay.

Conclusion

ECMO was effective in three HIV-positive patients with an otherwise fatal respiratory failure. All patients had severe immunosuppression and/or limited antiretroviral options. A multidisciplinary critical team is needed to individualize the use of ECMO in immunocompromised patients, including those with HIV infection.

Keywords:
ECMO; HIV; AIDS; HAART; ARDS; Pneumonia; PJP; Legionella; Immunocompromised patients