ARDS in HIV Patients and VV ECMO Considerations (Mohamed Hussein Ahmed)
HIV Patients on ECMO Bridge
Mohamed Hussein presented a case series of three HIV patients treated with ECMO at the Manchester ECMO Center, highlighting that ECMO can be successfully used as a bridge to recovery in selected patients with type 1 respiratory failure. The patients were young, newly diagnosed with HIV, and had no significant comorbidities. The ECMO duration was prolonged, averaging about a month, and patients experienced prolonged ICU and hospital stays. Hussein emphasized the importance of careful patient selection and discussed the challenges and complications associated with managing HIV patients on ECMO.
ECMO Treatment and Patient Outcomes
Hussein presented two ECMO cases, describing the treatment protocols and challenges faced. The first patient, a male with necrotizing pneumococcal pneumonia, was treated with antiretroviral therapy, steroids, IVIG, and Acyclovir for HSV-1, while battling complications including Aki, multi-organ failure, and invasive pulmonary aspergillosis. The second patient, a 28-year-old female with newly diagnosed HIV and severe ARDS, was successfully cannulated and retrieved on VV-ECMO, requiring tracheostomy and prolonged ICU and hospital stays. Both patients showed significant improvement in imaging and clinical outcomes.
ECMO Cases in HIV Patients
Hussein presented two cases of ECMO patients with HIV and Pneumocystis jiroveci pneumonia (PJP). The first patient required two rounds of ECMO, antiretroviral therapy, and second-line treatment for PJP, while the second patient was admitted twice with respiratory failure, initially managed with ECMO and antiretroviral therapy. Both patients faced challenges including absorption issues, co-infections, and complications such as DVT and intracerebral bleed, but showed significant improvement in their lung condition after treatment.
HIV Patient ECMO Case Study
Hussein presented a case study of a patient with HIV who required ECMO support for a month due to severe respiratory failure. The patient experienced multiple complications including CMV infection, gastrointestinal bleeding, and deep vein thrombosis, but showed significant improvement on imaging after ECMO weaning. Hussein emphasized the importance of multidisciplinary team meetings in ECMO care and highlighted key learning points for managing HIV patients on ECMO, including the need for careful cannulation, prolonged ECMO duration, and close monitoring for bleeding and thrombosis risks.
HIV Management and Treatment Strategies
Hussein presented on HIV infection management, recommending early involvement of specialists and high-dose septrin alongside steroids. He highlighted a high incidence of viral co-infections and secondary infections, advocating for early antiretroviral treatment within the first week despite the risk of immune reconstitution inflammatory syndrome. Hussein also discussed complications like gut failure and specific conditions like Kaposi’s sarcoma, noting that antiretroviral treatment alone was effective without chemotherapy, and addressed HLH with bulse steroids and IVIG.