A 19-year-old woman, with a past medical history of Steinert's myotonic dystrophy, intubated due to severe respiratory distress after an exploratory laparotomy for intestinal pseudo-obstruction. In tracheal aspirate, Escherichia coli without resistance mechanisms. Very poor pulmonary mechanics (compliance < 2 mL/cmH2O) and no response to prone positioning, veno-venous ECMO is cannulated, and given the high airway pressures with 4 mL/kg of ideal body weight, ventilation is switched to airway pressure release ventilation (APRV): high pressure 15 cmH2O; high time 6 s; low time 0.3 s. Initially 10 mL of exhaled volume. Radiographic progression is shown in the images (Fig. 1: day 0; Fig. 2: day 2; Fig. 3: day 5). This case is an example of how APRV ventilation while ensuring gas exchange with ECMO can be useful in the management of patients with refractory respiratory distress.
Funding
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None declared.
