Failure of extracorporeal membrane oxygenation to rescue acute respiratory distress syndrome caused by dual infection of influenza A (H1N1) and invasive pulmonary aspergillosis

摘要

Invasive pulmonary aspergillosis (IPA) is a well-known cause of morbidity and mortality in immunocompromised patients. However, the incidence of IPA in critically ill patient with influenza is rising, even in the absence of immunodeficiency. IPA was diagnosed in ～23–32% of influenza patients who stayed in intensive care units.1, 2 In this situation, there are relevant difficulties in timely diagnosis and treatment by the intensivists because of various nonspecific clinical signs and lack of unequivocal diagnostic criteria.3 Therefore, the patients with coinfected influenza and IPA have ～88% morbidity of acute respiratory distress syndrome (ARDS)2 and ～50–60% of mortality.2, 4 Venovenous extracorporeal membrane oxygenation (v-v ECMO) with prone position was reported to save two adult patients with severe ARDS by H1N1 pneumonia with IPA.5 We report a patient with this dual infection; however, our efforts, using intensive therapy including v-v ECMO, failed to achieve success.