Severe ARDS caused by adenovirus: early initiation of ECMO plus continuous renal replacement therapy.

Sang Ook Ha,Sang Jin Han,Ki-Suck Jung,Sunghoon Park,Hyun-Sook Kim,Hyoung Soo Kim,Seung Hun Jang,Sun Hee Lee

doi:10.1186/s40064-016-3571-9

Abstract

The reported survival rates of patients with acute respiratory distress syndrome (ARDS) caused by human adenovirus (HAdV) pneumonia are poor. The results do not differ much in immunocompetent patients supported by extracorporeal membrane oxygenation (ECMO). We report two immunocompetent patients with severe ARDS complicating HAdV pneumonia who were treated successfully and survived to discharge. Compared with previous cases, our cases might have benefited from several factors. First, the time interval between mechanical ventilator support and ECMO implantation was shorter. Second, we implemented conservative fluid management as recommended by the ARDS network using continuous renal replacement therapy (CRRT). Third, we administered an antiviral agent as early as possible. A clinical trial of early ECMO with CRRT and the administration of cidofovir in patients with severe ARDS complicating HAdV pneumonia are needed to confirm our results.

Highlights

Severe acute respiratory distress syndrome (ARDS) complicating adenovirus pneumonia has been a concern in immunocompetent adults since CDC (2001) reported two adenovirus pneumonia-related deaths in 2001
We present two cases of severe ARDS caused by human adenovirus (HAdVs) pneumonia for whom the early initiation of Extracorporeal membrane oxygenation (ECMO) plus continuous renal replacement therapy (CRRT), together with an antiviral agent, was tried
On intensive care unit (ICU) day 2, HAdV was identified by polymerase chain reaction (PCR) in a sputum specimen obtained at the time of admission, and she was given cidofovir 5 mL/kg/ week for 2 weeks

Summary

Introduction

Severe acute respiratory distress syndrome (ARDS) complicating adenovirus pneumonia has been a concern in immunocompetent adults since CDC (2001) reported two adenovirus pneumonia-related deaths in 2001. Human adenovirus (HAdV) serotypes 3 and 7 accounted for the majority of severe infections; serotype 55 was recently identified as a pathogen of acute fatal pneumonia in immunocompetent adults (Yang et al 2009; Kajon et al 2010; Gu et al 2012; Zhang et al 2012; Cao et al 2014). Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy for patients with severe ARDS caused by HAdV, but the outcome was not satisfactory (Gu et al 2012; Sun et al 2014; Prodhan et al 2014). We present two cases of severe ARDS caused by HAdV pneumonia for whom the early initiation of ECMO plus CRRT, together with an antiviral agent (cidofovir), was tried

Methods

Results

Discussion

Conclusion