Lung protection strategy based on transpulmonary pressure could repel the need for extracorporeal membrane oxygenation in a neonate with severe acute respiratory distress syndrome

Abstract

This report presents the case of a neonate with septic shock and acute respiratory distress syndrome (ARDS) caused by invasive group A streptococcal infection. Mechanical ventilation was performed with plateau pressure of 28 cmH₂O and PEEP of 8 cmH₂O. However, progressive hypoxemia continued and extracorporeal membrane oxygenation (ECMO) was considered. At this point, esophageal pressure was measured and transpulmonary pressure was calculated as 18 cmH₂O. Based on previous research indicating that transpulmonary pressures of ≤25 cmH₂O does not exacerbate pulmonary injury, the plateau pressure was increased to 38 cmH₂O and PEEP to 14 cmH₂O. Hypoxemia improved, septic shock was treated successfully, and the neonate was extubated on day 8 and discharged from the ICU on day 13. This case suggests that ECMO can be avoided in neonates with rapidly progressive severe ARDS by adjusting ventilation support based on transpulmonary pressure.