PMC8058468_01
Patient's clinical history from admission to the university center intensive care unit (ICU) on day 12 after first symptoms. The immunomodulatory therapy is shown in red and the antibiotic therapy in green. Additional ECMO cannulation on day 18 (marked with *), dexamethasone administration 6 mg intravenously (i.v.) per day for 10 days (started before ICU admission). Interferon-y (IFNy) administration on the 28th day with a single dose of 100 mcg subcutaneously (s.c.). vv-ECMO (veno-venous extracorporeal membrane oxygenation). BS/TS (found in blood culture and tracheal secretion).
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To overcome this critical hypoxemia a secondary venous cannula was implanted on day 18 to increase ECMO blood-flow up to 7 L/min (Figure 1). ARDS was made by the detection of Haemophilus influenzae, which was first treated with piperacillin/tazobactam for 6 days. Antibiotic treatment was switched to meropenem and ciprofloxacin after detection of a resistant Pseudomonas aeruginosa (3-MRGN) and a non-resistant Klebsiella oxytoca (Figure 1).
Caption shows the x-ray findings of the patient's lungs on day 12 (A) and on day 28 (B). Flow-cytometry (FACS) results of monocytic human leukocyte antigen receptors (mHLA-DR) on monocyte (CD 14+) before administration of interferon-y (IFNy) on day 26 (C) and after interferon-y (IFNy) treatment on day 29 (D).
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Sequential chest X-ray examinations showed infiltration, congestion and severe pneumonia (Figure 2).