ty -jour t1-急性呼吸窘迫综合征的体外膜氧化因肺炎刺激而导致的肺炎肺炎 pneumonia jf-欧洲呼吸杂志AU - Stahl, Klaus AU - Schenk, Heiko AU - Seeliger, Benjamin AU - Wiesner, Olaf AU - Schmidt, Julius J. AU - Bauersachs, Johann AU - Welte, Tobias AU - Kühn, Christian AU - Haverich, Axel AU - Hoeper，Marius M.Au -David，Sascha Y1-2019/09/01 UR -http：//www.qdcxjkg.com/content/54/3/3/1900410.Abstract N2 -Pneumocystis jirovecii jirovecii pneumonia（pcp）偶尔出现，偶尔出现在免疫性的患者中，偶尔出现。。大约50％的PCP与HIV有关，另一半与免疫抑制有关[1]。如果PCP发展为需要重症监护和侵入性机械通气的急性呼吸窘迫综合征（ARDS），则预后通常很差[1]，如果需要额外的静脉外膜外膜（VV-ECMO），则死亡率约为80％。[1]。尽管缺乏明确的证据[2]，VV-ECMO已成为严重ARDS救援疗法不可或缺的一部分。此外，一些中心在早期开始启动VV-ECMO，以便严格遵循（超）保护性通风策略[3]。到目前为止，仅根据单个病例报告，包括一例Awake ECMO [4]，才报告了与PCP相关ARDS患者的VV-ECMO。在清醒和自发呼吸的患者中使用ECMO可能会避免与镇静和侵入性机械通气有关的并发症。 Our group was the first to describe this awake ECMO approach in a bridge-to-transplant setting [5, 6] as well as in a small number of ARDS patients [7, 8]. However, evidence on the safety and efficacy of awake VV-ECMO strategies in this population is lacking [7]. PcP classically leads to an isolated single organ failure without accompanying systemic complications such as septic shock with haemodynamic instability or acute kidney injury (AKI). At the same time, these patients often require prolonged invasive mechanical ventilation with a high risk of complications including ventilator-associated pneumonia and pneumothorax. Hence, patients with PcP and severe hypoxaemia may be candidates for an awake ECMO strategy as a bridge to recovery.Extracorporeal membrane oxygenation (ECMO) may be justified in immunocompromised patients with Pneumocystis-associated acute respiratory distress syndrome, and an awake ECMO strategy might be feasible in selected patients http://bit.ly/2YFyrOK ER -