scholarly journals Extra Corporeal Membrane Oxygenation in the Treatment of Human Immunodeficiency Virus-Related P. jirovecii Pneumonia

2021 ◽  
Vol 13 (4) ◽  
pp. 1009-1017
Author(s):  
Sara Lacerda Pereira ◽  
Elsa Branco ◽  
Ana Sofia Faustino ◽  
Paulo Figueiredo ◽  
António Sarmento ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Distress Syndrome ◽  
Immune Status ◽  
Clinical Course ◽  
Ecmo Support ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Membrane Oxygenation ◽  
Ventilator Induced Lung Injury ◽  
Immunodeficiency Virus ◽  
Related Mortality

Despite the undeniable complexity one may encounter while managing critically ill patients with human immunodeficiency virus infection (HIV), intensive care unit-related mortality has declined in recent years, not only because of more efficacious antiretroviral therapy (ART) but also due to the advances in critical support. However, the use of extracorporeal membrane oxygenation (ECMO) in these patients remains controversial. We report four cases of HIV-infected patients with Pneumocystis jirovecii pneumonia (PJP) and acute respiratory distress syndrome (ARDS) treated with ECMO support and discuss its indications and possible role in the prevention of barotrauma and ventilator- induced lung injury (VILI). The eventually favorable clinical course of the patients that we present suggests that although immune status is an important aspect in the decision to initiate ECMO support, this technology can provide real benefit in some patients with severe HIV-related refractory ARDS.

scholarly journals Human Immunodeficiency Virus and Allergic Bronchopulmonary Aspergillosis: Case Report and Review of Literature

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Panagis Galiatsatos ◽  
Michael T. Melia ◽  
Leann L. Silhan
Keyword(s):  
Human Immunodeficiency Virus ◽  
Infected Patient ◽  
Progressive Disease ◽  
Distress Syndrome ◽  
Case Reports ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Hypersensitivity Response ◽  
Review Of Literature ◽  
Immunodeficiency Virus

Abstract Allergic bronchopulmonary aspergillosis (ABPA) results from a hypersensitivity response to airways colonization with Aspergillus fumigatus, and it occurs most often in individuals with asthma or cystic fibrosis. Allergic bronchopulmonary aspergillosis is an indolent, but potentially progressive, disease in patients. In patients infected with human immunodeficiency virus (HIV), ABPA is rare, and its description in the literature is limited to case reports. We describe the occurrence of ABPA in a 37-year-old woman with well controlled HIV infection. This represents the first documented case of ABPA in an HIV-infected patient whose only pulmonary comorbidity included the ramifications of prior acute respiratory distress syndrome due to Pneumocystis jirovecii pneumonia. We also review prior case reports of ABPA in HIV-infected patients and consider risk factors for its development.

scholarly journals Gag sequence variation in a human immunodeficiency virus type 1 transmission cluster influences viral replication fitness

2013 ◽  
Vol 94 (2) ◽  
pp. 354-359 ◽  
Author(s):  
Esther F. Gijsbers ◽  
Ad C. van Nuenen ◽  
Hanneke Schuitemaker ◽  
Neeltje A. Kootstra
Keyword(s):  
Human Immunodeficiency Virus ◽  
Human Immunodeficiency Virus Type ◽  
Sequence Variation ◽  
Clinical Course ◽  
Immunodeficiency Virus ◽  
Compensatory Mutations ◽  
Replication Fitness ◽  
Hiv 1

Three men from a proven homosexual human immunodeficiency virus type 1 (HIV-1) transmission cluster showed large variation in their clinical course of infection. To evaluate the effect of evolution of the same viral variant in these three patients, we analysed sequence variation in the capsid protein and determined the impact of the observed variation on viral replication fitness in vitro. Viral gag sequences from all three patients contained a mutation at position 242, T242N or T242S, which have been associated with lower virus replication in vitro. Interestingly, HIV-1 variants from patients with a progressive clinical course of infection developed compensatory mutations within the capsid that restored viral fitness, instead of reversion of the T242S mutation. In HIV-1 variants from patient 1, an HLA-B57+ elite controller, no compensatory mutations emerged during follow-up.

scholarly journals Spontaneous breathing in patients with severe acute respiratory distress syndrome receiving prolonged extracorporeal membrane oxygenation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingen Xia ◽  
Sichao Gu ◽  
Min Li ◽  
Donglin Liu ◽  
Xu Huang ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ecmo Support ◽  
Invasive Ventilation ◽  
Membrane Oxygenation ◽  
Native Lung

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in awake, spontaneously breathing and non-intubated patients (awake ECMO) may be a novel therapeutic strategy for severe acute respiratory distress syndrome (ARDS) patients. The purpose of this study is to assess the feasibility and safety of awake ECMO in severe ARDS patients receiving prolonged ECMO (> 14 days). Methods We describe our experience with 12 consecutive severe ARDS patients (age, 39.1 ± 16.4 years) supported with awake ECMO to wait for native lung recovery during prolonged ECMO treatment from July 2013 to January 2018. Outcomes are reported including the hospital mortality, ECMO-related complications and physiological data on weaning from invasive ventilation. Results The patients received median 26.0 (15.5, 64.8) days of total ECMO duration in the cohort. The longest ECMO support duration was 121 days. Awake ECMO and extubation was implemented after median 10.2(5.0, 42.9) days of ECMO. Awake ECMO was not associated with increased morbidity. The total invasive ventilation duration, lengths of stay in the ICU and hospital in the cohort were 14.0(12.0, 37.3) days, 33.0(22.3, 56.5) days and 46.5(27.3, 84.8) days, respectively. The hospital mortality rate was 33.3% (4/12) in the cohort. Survivors had more stable respiratory rate and heart rate after extubation when compared to the non-survivors. Conclusions With carefully selected patients, awake ECMO is a feasible and safe strategy for severe pulmonary ARDS patients receiving prolonged ECMO support to wait for native lung recovery.

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