Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia.
To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center.
Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016.
A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia.
Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to "lung rest" settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13).
In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.
1 Department of Emergency and Intensive Care Medicine, Centro Hospitalar S.João, Porto, Portugal.|2 Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal.
Roberto
R
Roncon-Albuquerque
2 Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto, Porto, Portugal.
Rodrigo
R
Vilares-Morgado
3 Department of Internal Medicine, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Póvoa de Varzim, Portugal.
Gert-Jan
GJ
van der Heijden
4 Department of Internal Medicine, Centro Hospitalar S.João, Porto, Portugal.
João
J
Ferreira-Coimbra
1 Department of Emergency and Intensive Care Medicine, Centro Hospitalar S.João, Porto, Portugal.
Paulo
P
Mergulhão
1 Department of Emergency and Intensive Care Medicine, Centro Hospitalar S.João, Porto, Portugal.|5 Department of Medicine, Faculty of Medicine of Porto, Porto, Portugal.
José Artur
JA
Paiva
D000328:Adult; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D006801:Humans; D007875:Legionella; D007877:Legionnaires' Disease / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000382:microbiology / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate; D016896:Treatment Outcome
 pneumonia; acute respiratory distress syndrome; extracorporeal membrane oxygenation