Lung protective strategy resusciated a near-drowning elderly patient with severe hypoxemia

Abstract

An 86-year-old female patient with severe ARDS resulted from near-drowning was admitted to our ICU. The patient's PaO₂ value is 31mmHg with 100% oxygen inhalation and a PEEP of 17cm H₂O when we started mechanical ventilation with pressure support of 15cm H₂O. Since rising a level of PEEP to 20cm H₂O caused little increase of PaO₂ and critical deterioration of hemodynamics, we decided to accept hypoxemia to maintain hemodynamic stability. Peak airway pressure was set at 30cm H₂O to avoid ventilator-induced lung injury. Although the PaO₂ values were less than 40mmHg for 7 hours and less than 50mmHg for 22 hours, we could not point out hypoxic damage in any one of vital organs with intensive monitoring.
The patient has recovered without any residual dysfunction of vital organs and we attribute her recovery in part to lung protective strategy despite long-term hypoxemia.