The Successful Use of Extracorporeal Membrane Oxygenation in a Newly Diagnosed HIV Patient with Acute Respiratory Distress Syndrome (ARDS) Complicated by Pneumocystis and Cytomegalovirus Pneumonia: A Case Report

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for inviting me to review this clinical case.

I find the case interesting especially for the final clinical outcome despite the considerable severity and the particularity of the use of ECMO support in this clinical setting which could be considered controversial. In fact, it will be of interest to the readers to know certain particularities of the case that could be taken into account by the readers to apply them in their daily clinical practice. In this regard, I consider that the authors should improve the writing of the case evolution, better structuring its evolution and describing relevant clinical aspects, such as hemodynamic repercussions, pulmonary mechanical involvement secondary to CMV (it is more predominant than the involvement of oxygenation), among others.

Comments on the Quality of English Language

Authors should use more scientific terminology appropriate to the target readers. 

Author Response

Reviewer #1

Comment: I find the case interesting especially for the final clinical outcome despite the considerable severity and the particularity of the use of ECMO support in this clinical setting which could be considered controversial. In fact, it will be of interest to the readers to know certain particularities of the case that could be taken into account by the readers to apply them in their daily clinical practice. In this regard, I consider that the authors should improve the writing of the case evolution, better structuring its evolution and describing relevant clinical aspects, such as hemodynamic repercussions, pulmonary mechanical involvement secondary to CMV (it is more predominant than the involvement of oxygenation), among others.

Response: Thank you for your comment. We have made some adjustments to further improve the flow and the structure as suggested. We have added subheadings such as initial presentation, transfer of care, ECMO course, and other hospital course. We have elaborated more on the hemodynamic repercussions and pulmonary mechanical involvement under “ECMO course” section from line 74-85.

Reviewer 2 Report

Comments and Suggestions for Authors

I read this paper with great interest. Authors thoroughly detail the medical journey of a complex patient with dual opportunistic infections, successfully treated VV-ECMO, ART, and targeted antimicrobial therapies. I think it's a very well-written case report. 

 

I have only some minor comments:

 

-Authors mention adjustments to ECMO settings. Please provide additional clarity on the rationale behind specific changes.  

 

-Authors briefly mentioned significant complications, such as pnx, recurrent bacteremia, and subarachnoid hemorrhage. Please provide a more detailed discussion on the management of these complications, particularly in the context of ECMO.

 

-The conclusion mentions the need for further studies to validate these findings. Please expand on specific research areas that could be explored (e.g., predictors for ECMO success in immunocompromised patients, optimal timing for ART in ARDS).

Author Response

Reviewer #2:

I read this paper with great interest. Authors thoroughly detail the medical journey of a complex patient with dual opportunistic infections, successfully treated VV-ECMO, ART, and targeted antimicrobial therapies. I think it's a very well-written case report. 

I have only some minor comments:

 

-Authors mention adjustments to ECMO settings. Please provide additional clarity on the rationale behind specific changes.

Response: Thank you for your comment. We decreased the ECMO flow and sweep because patients began to take some tidal volume and showed some signs of respiratory recovery when patient was on minimal mechanical ventilator support setting with pressure control under PEEP 10 and FiO₂ 40%. We have added the phrase in line 90-91.

 

 

-Authors briefly mentioned significant complications, such as pnx, recurrent bacteremia, and subarachnoid hemorrhage. Please provide a more detailed discussion on the management of these complications, particularly in the context of ECMO.

Response: Thank you for your comment. We have elaborated a more detailed discussion on the management of these complications in line 102-109. 

 

 

-The conclusion mentions the need for further studies to validate these findings. Please expand on specific research areas that could be explored (e.g., predictors for ECMO success in immunocompromised patients, optimal timing for ART in ARDS).

Response: Thank you for your comment. We believe that clinical characteristics and predictors for ECMO success in immunocompromised patients, timing for ART in ARDS and its association with successful ECMO decannulation, and specific considerations and management on VV-ECMO in this type of patients should further be explored in future research. We have added new sentences in line 184-188.

 

 

-The conclusion mentions the need for further studies to validate these findings. Please expand on specific research areas that could be explored (e.g., predictors for ECMO success in immunocompromised patients, optimal timing for ART in ARDS).

Response: Thank you for this feedback. Please see the above response.