ECMO管理を要した重症COVID–19市中肺炎に対して腹臥位療法やステロイドの全身投与により軽快した2例(Two cases of severe coronavirus disease 2019 community–acquired pneumonia successfully treated with extracorporeal membrane oxygenation and prone positioning and systemic corticosteroid therapy)

(Jiro Kamiyama), 神山 治郎; (Koichi Yasaka), 八坂 剛一; (Saki Sakamoto), 坂本 早紀; (Katsura Hayakawa), 早川 桂; (Yuko Egawa), 江川 裕子; (Shigemasa Taguchi), 田口 茂正; (Kazuya Kiyota), 清田 和也

The first case was that of a 58–year–old man diagnosed with coronavirus disease 2019 (COVID–19) pneumonia after 7 days of fever. Favipiravir was administered on admission; however, the patient’s respiratory status worsened with high fever. On day 2 of admission, after tracheal intubation, maintaining oxygenation was difficult after initiating mechanical ventilation, and extracorporeal membrane oxygenation (ECMO) was initiated. On day 5, prone positioning and corticosteroid therapy were started. The patient was weaned from ECMO on day 9 and from ventilator support on day 11. On day 27, he was discharged ambulatory. The second case was that of a 44–year–old man who complained of dyspnea after 12 days of fever. After tracheal intubation, he was diagnosed with COVID–19 pneumonia. Favipiravir was administered on admission; nevertheless, the patient’s respiratory status worsened gradually with high fever. On day 4 of admission, ECMO and corticosteroid therapy were initiated. On day 5, prone positioning was started. The patient was weaned from ECMO on day 12 and from ventilator support on day 15. On day 30, he was discharged ambulatory. The aggravation of COVID–19 pneumonia may be associated with excessive inflammation; therefore, some patients were effectively treated with corticosteroid therapy.