title: Extra Corporeal Membrane Oxygenation (ECMO) in three HIV-positive patients with acute respiratory distress syndrome.
abstract: BACKGROUND
  Extracorporeal membrane oxygenation (ECMO) is a life-saving bridging procedure in patients with severe acute respiratory distress syndrome (ARDS). Official indications for ECMO are unclear for immunocompromised and HIV-positive patients affected by severe hypoxemia. Uncertainties are related to prognosis and efficacy of treatment of the underlying disease. However, the care of patients with HIV infection has advanced since the introduction of highly active antiretroviral therapy (HAART), with increased life expectancy and decreased mortality.
  
  
  METHODS
  Three HIV-infected patients with AIDS were admitted to ICU and were treated with ECMO: a 21 years old Caucasian female with congenital HIV infection presented with Pneumocystis jirovecii pneumonia (PJP); a 38 years old Caucasian female with HIV-HCV infection and L. pneumophila pneumonia; a 24 years old Caucasian male with fever, cough weight loss and PJP pneumonia. Two patients were alive, with a good immunovirological profile and they went back to their previous quality of life. The last patient died with septic shock after three months of ICU stay.
  
  
  CONCLUSIONS
  ECMO was effective in three HIV-positive patients with an otherwise fatal respiratory failure. All patients had severe immunosuppression and/or limited antiretroviral options. A multidisciplinary critical team is needed to individualize the use of ECMO in immunocompromised patients, including those with HIV infection.
authors.affiliation: Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: De Rosa
authors.affiliation: Department of Surgical Sciences, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Vito
authors.initials: V
authors.lastname: Fanelli
authors.affiliation: Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.affiliation: Department of Surgical Sciences, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Urbino
authors.affiliation: Department of Surgical Sciences, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonetto
authors.affiliation: Department of Surgical Sciences, Cardiosurgery Unit, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ricci
authors.affiliation: Department of Surgical Sciences, Cardiosurgery Unit, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.affiliation: Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.affiliation: Department of Medical Sciences, University of Turin, Infectious Diseases at Amedeo di Savoia Hospital, Corso Svizzera 164, 10149 Turin, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonora
authors.affiliation: Department of Surgical Sciences, University of Turin, City of Health and Science, Molinette Hospital, C.so Dogliotti 14, 10126 Turin, Italy.
authors.forename: Marco V
authors.initials: MV
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011379:Prognosis; D011788:Quality of Life; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
keywords: AIDS; ARDS; ECMO; HAART; HIV; Immunocompromised patients; Legionella; PJP; Pneumonia