title: A case of severe ARDS caused by novel swine-origin influenza (A/H1N1pdm) virus: a successful treatment with direct hemoperfusion with polymyxin B-immobilized fiber.
abstract: In 2009, a 35-year-old female with Down syndrome was admitted to our hospital because of severe pneumonia caused by an infection with the novel swine-origin influenza (A/H1N1pdm) virus (S-OIV). A chest X-ray on admission revealed bilateral infiltration shadows. Although mechanical ventilation was administered because of the development of ARDS, the hypoxemia continued to progressed. We observed evidence of alveolar hemorrhage on evaluation of the patient using bronchofiberscopy. The bacterial examination was negative. Despite intensive care, including respiratory management with high-frequency oscillatory ventilation (HFOV), the patient's hypoxemia and hypotension progressed. We concluded that a cytokine storm due to the influenza infection with SIRS caused shock status, resulting in septic shock. We subsequently treated the patient with direct hemoperfusion with polymyxin B-immobilized fiber (PMX-DHP). The hypoxemia improved immediately. She was free from mechanical ventilation and discharged from the hospital by the 17th day of her hospitalization. PMX-DHP seems to improve hypoxemia in patients with severe ARDS who cannot maintain sufficient respiratory control under mechanical ventilation. This case is the first report about severe and life-threatening ARDS due to the novel influenza, in which PMX-DHP showed beneficial effects.
authors.affiliation: First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tateishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Tsushima
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Agatsuma
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
authors.forename: Keishi
authors.initials: K
authors.lastname: Kubo
mesh_terms: D000328:Adult; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006612:High-Frequency Ventilation; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications*; D011112:Polymyxin B / Q000008:administration & dosage*; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy*
chemical_list: D011112:Polymyxin B