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Severe adenovirus pneumonia requiring extracorporeal membrane oxygenation support--Serotype 7 revisited
1Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore.
Introduction:
Adenovirus causing severe fatal pneumonia has been well described in infants, children, and patients with immunocompromised function, but reports in previously healthy adults are rare. We report 3 cases of severe adenovirus pneumonia in whom conventional mechanical ventilation failed and required extracorporeal membrane oxygenation support.
Methods:
Retrospective case records review of 3 patients admitted to the medical intensive care unit, Singapore General Hospital, a tertiary care university-affiliated hospital, with severe adenovirus pneumonia requiring extracorporeal membrane oxygenation support from February to March 2013.
Results:
All 3 patients were previously healthy immunocompetent adults from the community with negative HIV serology. Duration prior to development of respiratory failure requiring intubation and invasive mechanical ventilation was 2, 8 and 3 days. Veno-venous extracorporeal membrane oxygenation (ECMO) support as rescue ventilation was instituted in all 3 patients after 2, 16, and 5 days of conventional mechanical ventilator support. Duration on ECMO support was 16, 22, and 9 days and mechanical ventilation was 18, 62, and 19 days respectively. Length of stay in intensive care unit was 18, 68, and 21 days, and length of stay in hospital was 20, 70, and 31 days respectively. Two of the 3 patients died.
Conclusion:
The mainstay of treatment for patients with severe adenovirus pneumonia is still supportive, with the use of antivirals not apparently effective. Whilst ECMO support for rescue ventilation may be considered, the outcomes do not appear as promising as other viral pneumonias, mirroring that previously described in the paediatric population.
Insights
Severe adenovirus pneumonia is rare in healthy adults, often requiring extracorporeal membrane oxygenation (ECMO) when conventional ventilation fails. Outcomes for adults with adenovirus pneumonia treated with ECMO are not as promising as for other viral pneumonias.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Adenovirus pneumonia is typically severe in infants, children, and immunocompromised individuals.
- Reports of severe adenovirus pneumonia in previously healthy adults are uncommon.
Observation:
- This study reviewed 3 cases of severe adenovirus pneumonia in immunocompetent adults requiring extracorporeal membrane oxygenation (ECMO).
- Patients presented with rapid respiratory failure, necessitating mechanical ventilation and subsequently ECMO support.
- Two out of the three adult patients treated with ECMO ultimately died.
Findings:
- Conventional mechanical ventilation failed in all 3 adult patients with severe adenovirus pneumonia.
- Extracorporeal membrane oxygenation (ECMO) was used as a rescue therapy for respiratory failure.
- Treatment with antivirals did not appear effective, and supportive care remains the mainstay.
Implications:
- Severe adenovirus pneumonia in healthy adults is a critical condition with high mortality, even with ECMO.
- ECMO outcomes for adenovirus pneumonia in adults may be less favorable compared to other viral etiologies.
- Further research is needed to explore effective treatments for severe adenovirus pneumonia in adults.
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