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EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR ACUTE RESPIRATORY DISTRESS SYNDROME DUE TO PNEUMOCYSTIS JIROVECI PNEUMONIA IN AN INFANT WITH AIDS
  1. B Wiebe1,
  2. C H Fremerey1,
  3. U Pohlmann1,
  4. J Reckers2,
  5. C H Haun2,
  6. M Ehlen1
  1. 1Department of Neonatology and Paediatric Intensive Care, Asklepios Klinik St. Augustin, St. Augustin, Germany
  2. 2Department of Paediatric Cardiac Surgury, German Paediatric Heart Center, Asklepios Klinik St. Augustin, St. Augustin, Germany

Abstract

Background The use of extracorporeal membrane oxygenation (ECMO) for septic patients is still not generally accepted. To our knowledge there are no reports on ECMO for paediatric patients with severe respiratory failure with known HIV infection.

Case report We report on a 3½ month old female infant with failure to thrive and recurrent respiratory tract infections who was admitted to hospital with pneumonia. Empiric antibiotic therapy was commenced but within several days the child deteriorated to ARDS. Intensive care management included high frequency oscillation ventilation (HFOV), inhaled nitric oxide (iNO), corticosteroids and repeated surfactant instillation. Pneumocystis jiroveci could be detected in the tracheal aspirate and advanced septic work-up revealed infection with HIV type 1. As no satisfactory oxygenation could be achieved, we decided to apply ECMO (venovenous, 15 French cannulae, flow maximum 120 ml/kg/min) achieving respiratory as well as hemodynamic stability. The infant could be weaned off ECMO after 12 days. As soon as the diagnosis of HIV infection was established a highly active antiviral therapy (HAART) was commenced, resulting in a significant reduction of virus load. After 136 days the child could be discharged. So far only treatment on outpatient basis has been necessary.

Discussion We show that the application of ECMO in early infancy for treatment of severe respiratory failure due to AIDS can be successful. As new antiviral treatment regimens may offer better outcome results the indication for implementing invasive therapeutic strategies such as ECMO in those children has to be discussed.

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