Severe Adenovirus Pneumonia Requiring Extracorporeal Membrane Oxygenation Support in Immunocompetent Children

Abstract

Objective: To highlight severe adenovirus pneumonia in immunocompetent patients by analysis of severe adenovirus pneumonia associated with acute respiratory distress syndrome in whom extracorporeal membrane oxygenation (ECMO) support is required. Methods:Pediatric patients with adenovirus pneumonia and ECMO supports in our hospital from February 2018 to May 2019 were retrospectively analyzed, and having 100 common adenovirus pneumonia children as a control. Results:A total of 8 patients, including 4 boys (50.0%), were enrolled. They were previously immunocompetent with a median age of 31 months. They were admitted as persistent fever and cough for more than one week. Median time prior to development of respiratory failure requiring intubation and invasive mechanical ventilation was 5 days. Venoarterial ECMO support as rescue ventilation was instituted after a median time of 24.5 h of conventional mechanical ventilator support. The median duration on ECMO support was 9 days and mechanical ventilation was 14 days, respectively. Six patients (75%) were recovered and 2 (25%) died. Median length of stay in ICU and hospital were 27.5 days and 47.5 days, respectively. Conclusion:The promising outcomes of our cases suggested that ECMO support for rescue ventilation may be considered when symptoms deteriorated in adenovirus pneumonia patients, and may improve outcome. However, sequelae of adenovirus pneumonia and ECMO-related complications should also be taken into account.

Keywords: acute respiratory distress syndrome; adenovirus pneumonia; extracorporeal membrane oxygenation; risk factors; survival rate.

Figure 1

Dynamic changes on chest X-ray (CXR) and CT scans of our 2 patients. Patient 2: CXR showed bilateral patch ground glass opacities in both lungs on hospital day (HD) 1.

Figure 2

Patient 2: Bilateral pneumonic consolidations with air bronchogram and pleural effusion were found in CT on HD 6.

Figure 3

Patient 2: The consolidations aggravated and extracorporeal membrane oxygenation (ECMO) support was instituted on HD 7.

Figure 4

Patient 2: The pneumonic consolidations were improved on HD 16 after 9 days of ECMO therapy.

Figure 5

Patient 7: CXR taken on HD 1 showed pneumonic consolidations in the right lobe with right pleural effusion.

Figure 6

Patient 7: CXR revealed bilateral “white lung” like changes and obvious air bronchogram on HD 6, suggesting ARDS, and ECMO was implemented.

Figure 7

Patient 7: CXR showed improved pneumonic conditions with remaining consolidations and atelectasis of right upper lobe on HD 15 after 9 days of ECMO therapy.

Figure 8

Patient 7: Consolidations in both lungs have further decreased on HD 29.