caa a22 4500 445373970 CHVBK 20180317142956.0 cr unu---uuuuu 170323e20110801xx s 000 0 eng 10.1007/s00540-011-1153-0 doi (NATIONALLICENCE)springer-10.1007/s00540-011-1153-0 Combination of extracorporeal membrane oxygenation and high-frequency oscillatory ventilation saved a child with severe ARDS after pulmonary resection [Elektronische Daten] [Eiji Hashiba, Futoshi Kimura, Yasuyuki Suzuki, Takeshi Asano, Tomoko Ono, Hirobumi Okawa, Toshihito Tsubo, Hironori Ishihara, Kazuyoshi Hirota] We report a case in which a 2-year-old girl who underwent a right middle and lower lung lobectomy for congenital cystic adenomatoid malformation suffered massive bleeding and developed acute respiratory distress syndrome (ARDS) during the operation. She was ventilated with a high level of FIO2 (0.75-1.0), PEEP (10-20cmH2O), and PIP (33-55cmH2O) to maintain SPO2 (>90%). Following transfer to the ICU, continuous hemodialysis was introduced to reduce excessive blood volume. However, pulmonary oxygenation did not improve, and marked subcutaneous emphysema occurred on postoperative day 3 (POD 3). We introduced venovenous (V-V) extracorporeal membrane oxygenation (ECMO) to rest the lung, and V-V ECMO was changed to right and left atrial ECMO because of unsatisfactory oxygen support on POD 23. A CT scan showed almost the entire lung had collapsed, even though we had administered diuretics, steroids, nitric oxide, sivelestat, and surfactant for ARDS. We applied high-frequency oscillatory ventilation (HFOV) with a mean airway pressure of 20cmH2O, frequency of 9.2Hz, and amplitude of 38cmH2O on POD 45. The collapsed lung was then gradually recruited, and pulmonary oxygenation improved (P/F ratio=434). ECMO was successfully weaned on POD 88. The patient required a tracheostomy, but she was able to function without a ventilator on POD 142. Although HFOV has failed to show a mortality benefit in ARDS patients, the unique lung recruitment by HFOV can be a useful therapeutic option for severe ARDS patients in combination with sufficient lung rest produced by ECMO. Japanese Society of Anesthesiologists, 2011 Extracorporeal membrane oxygenation nationallicence High-frequency oscillatory ventilation nationallicence ARDS nationallicence Postpneumonectomy pulmonary edema nationallicence Hashiba Eiji Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Kimura Futoshi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Suzuki Yasuyuki Department of Thoracic and Cardiovascular Surgery, Hirosaki University Postgraduate School of Medicine, Hirosaki, Japan aut Asano Takeshi Department of Neurosurgery, Hirosaki University Postgraduate School of Medicine, Hirosaki, Japan aut Ono Tomoko Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Okawa Hirobumi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Tsubo Toshihito Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Ishihara Hironori Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Hirota Kazuyoshi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut Journal of Anesthesia Springer Japan 25/4(2011-08-01), 580-584 0913-8668 25:4<580 2011 25 540 https://doi.org/10.1007/s00540-011-1153-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00540-011-1153-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hashiba Eiji Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Kimura Futoshi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Suzuki Yasuyuki Department of Thoracic and Cardiovascular Surgery, Hirosaki University Postgraduate School of Medicine, Hirosaki, Japan aut NATIONALLICENCE 700 1- Asano Takeshi Department of Neurosurgery, Hirosaki University Postgraduate School of Medicine, Hirosaki, Japan aut NATIONALLICENCE 700 1- Ono Tomoko Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Okawa Hirobumi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Tsubo Toshihito Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Ishihara Hironori Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 700 1- Hirota Kazuyoshi Department of Anesthesiology, Hirosaki University Postgraduate School of Medicine, 5 Zaifu-cho, 036-8562, Hirosaki, Aomori, Japan aut NATIONALLICENCE 773 0- Journal of Anesthesia Springer Japan 25/4(2011-08-01), 580-584 0913-8668 25:4<580 2011 25 540 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer