Short-term prone positioning for severe acute respiratory distress syndrome after cardiopulmonary bypass: A case report and literature review

Table 1 Berlin definition and management of acute respiratory distress syndrome

Diagnostic criteria[5]	Onset within 1 wk of known clinical impairment or new/worsening respiratory symptoms; Bilateral shadows (on CXR or CT scan) not fully explained by effusions, lobar/lung collapse, or nodules; Respiratory failure not entirely explained by heart failure or fluid overload
Oxygenation impairment[5]	Mild; 200 mmHg < PaO2/FiO2 ≤ 300 mmHg with PEEP or continuous positive airway pressure ≥ 5 cmH2O	Moderate 100 mmHg < PaO2/FiO2 ≤ 200 mmHg with PEEP ≥ 5 cmH2O	Severe PaO2/FiO2 ≤ 100 mmHg with PEEP ≥ 5 cmH2O
Risk factors for ARDS[5,16,17]	Infectious risk factors: Pneumonia, nonpulmonary sepsis	Noninfectious: Aspiration of gastric contents, severe trauma, pulmonary contusion, noncardiogenic shock, inhalation injury, severe burns, pancreatitis, drug overdose, multiple transfusions or TRALI, pulmonary vasculitis, drowning
Oxygen therapy	Intubation/mechanical ventilation (most patients)Noninvasive ventilation for mild ARDS
Fluid management	Aim for central venous pressure < 4 mmHg or PAOP < 8 mmHg to ↓ pulmonary; Oedema
Prone positioning
ECMO
Decreased oxygen consumption; Increased oxygen delivery[7]	Antipyretics, sedatives, analgesics and paralysis agents; Inotropics to ↑ filling pressure (if no pulmonary edema); Restrict transfusions to maintain hemoglobin to 7–9 g/dL; Inhaled vasodilators (NO, prostacyclin and prostaglandin E1) to ↑ V′/Q′ matching

ARDS: Acute respiratory distress syndrome; CXR: Chest X-ray; CT: Computed tomography; ECG: Electro-chemical grinding; FIO₂: Fraction inspired oxygen; PaO₂: Partial pressure of arterial oxygen; PAOP: Pulmonary artery occlusion pressure: PEEP: Positive end-expiratory pressure; TRALI: Transfusion-related acute lung injury; V′/Q′: Ventilatory blood flow ratio.