Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia

• Type: Article in International Scientific Journal
• Date: 2019

Authors

Roncon-Albuquerque R Jr (Author) FMUP; Vilares Morgado, R (Author) Other; van der Heijden, GJ (Author) Other; Ferreira Coimbra, J (Author) Other; Mergulhao, P (Author) FMUP; Paiva, J-A (Author) FMUP

Journal

The Journal is awaiting validation by the Administrative Services.

Title: JOURNAL OF INTENSIVE CARE MEDICINE

Vol. 34

Pages: 344-350

ISSN: 0885-0666

Indexing

ISI Web of Knowledge - 5 Citations

Scopus - 4 Citations

Other information

Authenticus ID: P-00Q-989

DOI: 10.1177/0885066617700121

Abstract (EN): Objective: 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. Design and Setting: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.JoAo (Porto, Portugal), between November 2009 and September 2016. Participants: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Results: 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: Pao (2)/Fio (2) ratio 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/cmH(2)O) 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). Conclusion: 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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7