SEVERE PEDIATRIC ARDS SECONDARY TO INFLUENZA B WITH BACTERIAL COINFECTION SUCCESSFULLY MANAGED WITH VENO-VENOUS ECMO: A CASE REPORT

Severe viral-bacterial coinfection is increasingly recognized in Indian paediatric populations, with studies demonstrating a high overlap of viral (60%) and bacterial (45%) pathogens in hospitalized children with acute respiratory infections. Such coinfections can lead to rapid clinical deterioration, severe pneumonia, and progression to acute respiratory distress syndrome (ARDS), often necessitating intensive care support. Early recognition and aggressive management are therefore critical to improving outcomes in these critically ill patients.once hypoxemia crosses thresholds such as an oxygenation index (OI) > 16–25 or PaO2/FiO2 ratio < 100 despite optimal ventilation, mortality risk increases significantly, occasionally necessitating Extracorporeal Membrane Oxygenation (ECMO) as a salvage therapy. We report the case of a 4-year-old boy who presented with fever, cough, and progressive respiratory distress and was diagnosed with bilateral pneumonia with pleural effusion. Respiratory multiplex PCR identified Influenza B with bacterial coinfection including Streptococcus pneumoniae, Haemophilus influenzae, and methicillin-resistant Staphylococcus aureus. Despite escalation to invasive mechanical ventilation and maximal ventilatory support, the child developed refractory hypoxemia, left sided pneumothorax, and septic shock required dual vasopressor and antimicrobial agent. Veno-venous extracorporeal life support (VV-ECLS) was initiated as Murray score was more than 3.