Abstract
A 3.5-month-old infant girl developed severe lobar emphysema in the middle and lower lobes of the right lung after repair of right congenital diaphragmatic hernia. She was ventilated with high frequency oscillation plus intermittent mandatory ventilation. Pulmo-nary function, however, deteriorated, and PaO2/FIO2 went below 80mm Hg while PaCO2 went above 100mm Hg. She was scheduled for right middle and lower lobectomy. We used extracorporeal lung assist (ECLA) with a heparin-bonded membrane lung intra-and postoperatively. Heparin was administered with an initial dose of 80 units•kg-1 and a maintenance dose of 11∼22 units•kg-1•h-1 to maintain activated clotting time at 120∼140 sec. Normal blood coagulation was maintained during the course of ECLA. Pulmonary vessels were inadvertently severed during lobectomy, and massive amounts of blood flowed into the healthy left lung. Pulmonary gas exchange was severely disturbed, and most of the O2 supply and CO2 elimination were performed with an artificial membrane lung. Perioper-ative use of heparin-bonded ECLA proved to be essential to sustaining the life of this patient.
