Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2022; 10(36): 13435-13442
Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13435
Short-term prone positioning for severe acute respiratory distress syndrome after cardiopulmonary bypass: A case report and literature review
Jian-Hua Yang, Shu Wang, Yuan-Xiu Gan, Xuan-Yun Feng, Bai-Lin Niu
Jian-Hua Yang, Shu Wang, Bai-Lin Niu, Department of Intensive Care Medicine, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing Key Laboratory of Emergency Medicine, Chongqing 400016, China
Yuan-Xiu Gan, Xuan-Yun Feng, Department of Intensive Care Medicine, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing 400016, China
Author contributions: Niu BL contributed to the study conception and design; Yang JH, Gan YX, Feng XY and Wang S contributed to the data collection and analysis; Yang JH wrote the manuscript; Niu BL and Wang S revised the manuscript; All authors have read the manuscript and approved the final version to be published; Yang JH and Wang S contributed equally to this work.
Supported by the Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau), No. 2020FYYX163; Chongqing Medical Key Discipline Construction Project, No. ZDXK202103; Fundamental Research Funds for the Central Universities and Advanced Middle-Aged and Young Medical Talents Project in Chongqing, No. 2022CDJYGRH-014.
Informed consent statement: Written informed consent was obtained from the patient’s family for publication of the patient's medical imaging and related test results.
Conflict-of-interest statement: All the authors declare no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bai-Lin Niu, MD, Department of Intensive Care Medicine, Chongqing University Central Hospital, No. 1 Jiankang Road, Yuzhong District, Chongqing 400016, China. nberlin@126.com
Received: October 20, 2022
Peer-review started: October 20, 2022
First decision: November 11, 2022
Revised: November 22, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 67 Days and 11.5 Hours
Abstract
BACKGROUND

Aortic dissection is a complex and dangerous cardiovascular disease, with many complications in the perioperative period, including severe acute respiratory distress syndrome (ARDS), which affects prognosis and increases mortality. Despite the effect of prone positioning (PP) in improving oxygenation in patients with severe ARDS, reports about PP early after cardiac surgery are few and such an option may be an issue in cardiac surgery patients because of the recent sternotomy.

CASE SUMMARY

A 40-year-old male patient diagnosed with acute type A aortic dissection on October 22, 2021 underwent ascending artery replacement plus total aortic arch replacement plus stent elephant trunk implantation under cardiopulmonary bypass. Unfortunately, he developed ARDS on postoperative day 1. Despite comprehensive treatment with aggressive pulmonary protective ventilation, fluid management with continuous renal replacement therapy, the condition continued to deteriorate and rapidly progressed to severe ARDS with a minimum oxygenation index of 51. We are ready to implement salvage therapy, including PP and extracorporeal membrane oxygenation (ECMO). Due to the large amount of pericardial mediastinal and thoracic drainage after thoracotomy, ECMO may result in massive postoperative bleeding. Prolonged prone ventilation is often inappropriate after thoracotomy. Therefore, we chose short-term PP for < 6 h. Finally, the oxygenation index greatly improved and the diffuse exudation in both lungs of the patient was significantly reduced with short-term prone positioning.

CONCLUSION

Intermittent short-term PP can improve early postoperative severe ARDS after acute aortic dissection.

Keywords: Aortic dissection; Short-term prone positioning; Acute respiratory distress syndrome; Oxygenation index; Cardiopulmonary bypass; Case report

Core Tip: Severe acute respiratory distress syndrome (ARDS) is often secondary to cardiac macrovascular surgery. Extracorporeal membrane oxygenation (ECMO) and prone positioning (PP) can improve pulmonary ventilation blood flow ratio and survival rate. We report a case of aortic dissection complicated with severe ARDS, in which intermittent short-term PP successfully improved oxygenation in the absence of ECMO. It is not an absolute contraindication to prone ventilation in the early postoperative period after thoracotomy. The use of intermittent short-term PP can improve the condition and avoid the complications caused by early PP after thoracotomy.