Severe acute respiratory distress syndrome in a patient with AIDS successfully treated with veno-venous extracorporeal membrane oxygenation: a case report and literature review

Abstract

Case: Several successful uses of extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome in patients with novel HIV/AIDS infection have been reported; however, the therapeutic keys have not always been discussed.A 47-year-old man was admitted with progressive shortness of breath. He was in respiratory failure with a PaO₂/F_IO₂ ratio of 110.8 requiring intubation. Chest computed tomography showed diffuse ground glass opacities. An HIV infection was suspected, and a diagnosis of acute respiratory distress syndrome was made. Based on clinical indications, treatment for Pneumocystis jirovecii pneumonia and concomitant bacterial infection was started.

Outcome: Despite broad-spectrum antibiotics, the patient's oxygenation deteriorated, necessitating ECMO. After 19 days of ECMO therapy, the patient was successfully decannulated and was eventually discharged.

Conclusion: In acute respiratory distress syndrome in patients with HIV/AIDS refractory to treatment, ECMO should be considered. Post-ECMO antiretroviral therapy could improve outcomes.

Keywords: Acute respiratory distress syndrome; HIV/AIDS; V‐V ECMO; post‐ECMO ART.

Figure 1

Chest computed tomography and X‐ray findings in a patient with HIV/AIDS and severe acute respiratory distress syndrome treated with veno‐venous extracorporeal membrane oxygenation. A, Initial chest computed tomography. B, Portable chest X‐ray on hospital day 4. C, Portable chest X‐ray on hospital day 11, showing prominent bilateral consolidation. D, Portable chest X‐ray on hospital day 17, showing decreased lung consolidation.