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This article discusses a case study of a 25-year-old male with sickle cell disease (SCD) who developed acute chest syndrome (ACS) and severe acute respiratory distress syndrome (ARDS). The patient was successfully treated with veno-venous extracorporeal membrane oxygenation (V-V ECMO). ACS is a common cause of ICU admission for patients with SCD, and those requiring invasive mechanical ventilation for more than 96 hours have a higher risk of mortality. The use of ECMO in patients with ACS is limited, but this case suggests that it may be a viable treatment option for severe cases. However, further research is needed to optimize ECMO candidacy and care for patients with ACS. [Extracted from the article]

Rationale: Recent studies suggest that both hypo- and hyperinflammatory acute respiratory distress syndrome (ARDS) phenotypes characterize severe COVID-19-related pneumonia. The role of lung Severe Acute Respiratory Syndrome – Coronavirus 2 (SARS-CoV-2) viral load in contributing to these phenotypes remains unknown. Objectives: To redefine COVID-19 ARDS phenotypes when considering quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage of intubated patients. To compare the relevance of deep respiratory samples versus plasma in linking the immune response and the quantitative viral loads. Methods: Eligible subjects were adults diagnosed with COVID-19 ARDS who required mechanical ventilation and underwent bronchoscopy. We recorded the immune response in the bronchoalveolar lavage and plasma and the quantitative SARS-CoV-2 RT-PCR in the bronchoalveolar lavage. Hierarchical clustering on principal components was applied separately on the 2 compartments' datasets. Baseline characteristics were compared between clusters. Measurements and Results: Twenty subjects were enrolled between August 2020 and March 2021. Subjects underwent bronchoscopy on average 3.6 days after intubation. All subjects were treated with dexamethasone prior to bronchoscopy, 11 of 20 (55.6%) received remdesivir and 1 of 20 (5%) received tocilizumab. Adding viral load information to the classic 2-cluster model of ARDS revealed a new cluster characterized by hypoinflammatory responses and high viral load in 23.1% of the cohort. Hyperinflammatory ARDS was noted in 15.4% of subjects. Bronchoalveolar lavage clusters were more stable compared to plasma. Conclusions: We identified a unique group of critically ill subjects with COVID-19 ARDS who exhibit hypoinflammatory responses but high viral loads in the lower airways. These clusters may warrant different treatment approaches to improve clinical outcomes. [ABSTRACT FROM AUTHOR]