" Study of the Benefit of Nebulized Amikacin in the Treatment of Gram-negative Bacillus Pneumonia Acquired During Mechanical Ventilation in Patients Receiving Extracorporeal Membrane Veno-arterial Oxygenation "

Inclusion criteria

• Patient 18 years or older
• Circulatory assistance by veno-arterial ECMO for at least 24 hours prior to documentation of pneumonia
• Invasive mechanical ventilation
• Diagnostic suspicion of pneumonia based on evocative criteria (presence of at least 2 of the following criteria): fever (superior to 38. 5°C), hypothermia (inferior to 36.0°C), hyperleukocytosis (superior to 11 × 10^9 l-1) or leukopenia (inferior to 4 × 10^9 l-1), purulent tracheobronchial secretions, altered oxygenation with need to increase FiO2 on ECMO or ventilator for the same SaO2 or PaO2 target, new or persistent pulmonary infiltrate(s) on chest x-ray in bed, or image suggestive of pneumonia on chest CT, or consolidation of appearance suggestive of an infectious origin on pulmonary ultrasound.
• And microbiological confirmation of Gram-negative ventilator-associated pneumonia by quantitative culture on bronchoalveolar lavage (BAL, significance threshold superior to 10^4 CFU/ml) or protected distal sampling (PDP, significance threshold superior to 10^3 CFU/ml).
• Probabilistic antibiotic therapy with piperacillin - tazobactam
• Informed consent obtained from the patient or trusted support person if unable to consent at the time of inclusion, or inclusion procedure in emergency situations.
• Patient affiliated to social security (excluding AME)

Exclusion criteria

• Known allergy to amikacin or another aminoglycoside or to an auxiliary drug or to any of their excipients.
• Contraindication to the administration of amikacin or its excipients listed in the summary of product characteristics.
• Contraindication to the administration of an auxiliary drug or to one of its excipients listed in the summary of product characteristics.
• Contraindications to nebulization
• Intravenous antibiotic therapy started more than 72 hours before randomization
• Probabilistic venous antibiotic therapy other than piperacillin - tazobactam
• Administration of inhaled antibiotics within 7 days prior to inclusion
• Positive pregnancy test for women of childbearing potential
• Presence of HIV infection with CD4 count inferior to 200 cells/mm3 or fungal lung infection or pulmonary abscess or empyema
• Presence of renal insufficiency with creatinine clearance inferior to 15 ml/min, with the exception of patients receiving continuous renal purification or daily hemodialysis sessions as part of their intensive care unit management.
• Patent moribund (SAPS II superior to 75) or high probability of death within 48 hours
• Patient under legal protection (curatorship, guardianship or safeguard of justice)
• Participating in another interventional clinical trial or within the exclusion period at the end of a previous study.