The secretion clearance mode (SCM) provided by a biphasic cuirass ventilator (RTX^®) promotes airway clearance. SCM affects intrathoracic pressure and can change central hemodynamics. However, its effect on brain hemodynamics remains unknown. Hence, to investigate the effect of SCM on cerebral blood flow, the regional oxygen saturation (rSO₂) of the frontal lobe during SCM was measured using near-infrared spectroscopy. In three cases where SCM was used to improve pneumonia, the average amount of change in the rSO₂ during SCM was－2.1 to + 5.1% and did not correlate with the MAP, SpO₂, or PaCO₂. The findings suggested no abnormal changes in cerebral blood flow during the SCM.

A 58-year-old man with severe coronavirus disease and acute respiratory distress syndrome received mechanical ventilation and veno venous extracorporeal membrane oxygenation (ECMO). After long-term ECMO management, oxygenation improved; however, his lung compliance remained poor and persistent bacteremia was refractory to treatment. In order to reduce the cannulation sites and promote rehabilitation, his ECMO was switched to extracorporeal carbon dioxide removal (ECCO₂R) using a dialysis catheter and centrifugal pump on day 98. The decrease in minute ventilation and esophageal pressure swings suggested that ECCO₂R reduced respiratory effort and allowed for a lung protective ventilation strategy. ECCO₂R aims to eliminate blood CO₂, but there is no dedicated device in Japan. In this case, ECCO₂R using a dialysis catheter and centrifugal pump was safely performed. Although there is no clear indication for ECCO₂R, it may be effective in cases of difficult weaning after long-term ECMO.

Junctional ectopic tachycardia (JET) after pediatric heart surgery is often difficult to treat. A 2-month-old boy underwent total anomalous pulmonary venous return repair and pulmonary artery banding for asplenia and total anomalous pulmonary venous return. JET appeared after surgery, and antiarrhythmic drugs (amiodarone and landiolol) were administered in the operating room. In the PICU, in addition to the antiarrhythmic drugs, sedation management, electrolyte correction, body temperature control, catecholamine adjustment, and overpacing by atrial pacing were also performed. However, as the JET rate increased, management became difficult, and his hemodynamics deteriorated. By switching to R-wave synchronized atrial pacing, atrioventricular synchronization could be obtained without an increase in heart rate, and further deterioration of hemodynamics was prevented. Although this pacing mode has been used in Europe and the United States, it is not generally used in Japan. Therefore, R-wave synchronized atrial pacing is considered as one of the pacing mode options in the management of refractory JET.