Successful lung-protective ventilatory management during the VV-ECMO in a severe COVID-19 pneumonia patient with extensive pneumomediastinum and subcutaneous emphysema: a case report

JA Clinical Reports

Satoshi Hamada¹  Shinichi Kai²  Tomoharu Tanaka²  Jumpei Kohara²  Kazuya Hashimoto²  Yudai Takatani³  Kosai Cho³  Shigeru Ohtsuru³  Naoya Tanabe⁴  Isao Ito⁴ 

[1] Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan;Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan;Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan;Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;

关键词: COVID-19;    Pneumomediastinum/subcutaneous emphysema;    Veno-venous extracorporeal membrane oxygenation;    Lung-protective ventilation;   

DOI  :  10.1186/s40981-022-00505-8

来源: Springer

【 摘 要 】

BackgroundVentilatory management of respiratory failure with pneumomediastinum/subcutaneous emphysema is not established. Herein, we report a case of severe COVID-19 pneumonia with extensive pneumomediastinum/subcutaneous emphysema, rescued by thorough lung-protective ventilatory management after applying the VV-ECMO.Case presentationA 68-year-old male with no medical history was admitted to a local hospital and diagnosed with COVID-19 pneumonia. His pulmonary parameters worsened during invasive ventilation due to the development of pneumomediastinum/subcutaneous emphysema, and then he was transferred to our hospital. On arrival, we immediately decided to apply VV-ECMO and switch to ultraprotective ventilation. After maintaining the initial ventilation with a neuromuscular blocking agent for 2 days, we gradually increased PEEP while limiting PIP to 25 cmH2O. The patient was weaned off VV-ECMO on day 10; he was transferred to the medical ward after extubation.ConclusionsLung-protective ventilatory management should be performed thoroughly during VV-ECMO in severe COVID-19 pneumonia with pneumomediastinum/subcutaneous emphysema.

【 授权许可】

CC BY