Severe ARDS caused by adenovirus: early initiation of ECMO plus continuous renal replacement therapy

The reported survival rates of patients with acute respiratory distress syndrome (ARDS) caused by human adenovirus (HAdV) pneumonia are poor. The results do not differ much in immunocompetent patients supported by extracorporeal membrane oxygenation (ECMO). We report two immunocompetent patients with severe ARDS complicating HAdV pneumonia who were treated successfully and survived to discharge. Compared with previous cases, our cases might have benefited from several factors. First, the time interval between mechanical ventilator support and ECMO implantation was shorter. Second, we implemented conservative fluid management as recommended by the ARDS network using continuous renal replacement therapy (CRRT). Third, we administered an antiviral agent as early as possible. A clinical trial of early ECMO with CRRT and the administration of cidofovir in patients with severe ARDS complicating HAdV pneumonia are needed to confirm our results.