title: Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1-induced acute respiratory distress syndrome. Our experience and literature review.
abstract: We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative. Diagnosis is based on cytologic and histologic findings, viral cultures, or serologic methods. This condition can be reversible; however, often, it can progress into refractory ARDS with limited therapeutic options available. We demonstrate the causative role of HSV1 in refractory ARDS of a previously healthy 18-year-old man who presented to the intensive care unit with acute respiratory distress after a week of flulike syndrome. Due to severe hypoxemia and hypercarbia, the patient required mechanical ventilation and later emergent blood oxygenation with extracorporeal support. For the first time in this condition, we used venovenous ECMO management, to rest the lung, sustain blood oxygenation and end-organ oxygen delivery, and promote potential lung recovery. During ECMO and after our etiologic diagnosis, specific therapy was introduced. After viral negativization, corticosteroid therapy (Meduri protocol) was initiated. Extracorporeal membrane oxygenation allowed us to initiate therapy while maintaining end-organ oxygenation and support the patient until lung recovery. After 18 days of ECMO, our patient recovered completely. Near-normal lung structures and functions were documented on a chest x-ray/computed tomography, thoracic ultrasonography, and pulmonary functional tests at hospital discharge and at a 1-year follow-up. Data suggest that severe pulmonary involvement in HVS1 infection associated with septicemia/shock is a rare but often fatal in immunocompetent adult as well. We suggest that ECMO might be the selected treatment for severe refractory ARDS in this clinical scenario. It seems to be an effective and useful ultimate therapeutic strategy for preventing death and furthermore permitting near-full pulmonary function recovery.
authors.affiliation: Cardiac Surgery, Medical and Surgical Critical Care Department, University of Florence, Florence, Italy. massimo.bonacchi@unifi.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Bonacchi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Lascio
authors.forename: Guy
authors.initials: G
authors.lastname: Harmelin
authors.forename: Andrea
authors.initials: A
authors.lastname: Pasquini
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.forename: Guido
authors.initials: G
authors.lastname: Sani
mesh_terms: D000293:Adolescent; D015199:Extracorporeal Membrane Oxygenation; D006561:Herpes Simplex / Q000150:complications* / Q000000981:diagnostic imaging / Q000821:virology; D018259:Herpesvirus 1, Human; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy* / Q000821:virology; D014057:Tomography, X-Ray Computed