PMC7214613_01
Chest radiograms of Case 1: (A) At the time of ARDS diagnosis, an X-ray revealed bilateral diffuse lung opacities; (B) after two doses of surfactant plus budesonide treatment, a chest X-ray revealed better aeration.
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F1
A chest X-ray revealed bilateral diffuse lung opacities (Figure 1A), while blood gas analyses revealed respiratory acidosis with an oxygenation index of 12. The oxygenation index dropped to three after 12 h, the FiO2 level decreased to 0.35, and chest X-rays revealed better aeration (Figure 1B).
PMC7214613_02
Chest radiograms of Case 2: (A) At the time of ARDS diagnosis, an X-ray revealed bilateral irregular diffuse opacity; (B) improvement in lung aeration was seen after one dose of surfactant plus budesonide treatment.
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F2
Chest X-rays revealed bilateral irregular diffuse opacity (Figure 2A), and there was no cardiogenic origin for pulmonary edema, as confirmed by echocardiography. After a lung recruitment maneuver, the patient was ventilated on HFOV-VG mode and received a dose of 100 mg/kg surfactant (Poractant alfa, Curosurf, Chiesi Pharmaceuticals, Parma, Italy) plus 0.25 mg/kg budesonide (Pulmicort nebulizing suspension, Astra Zeneca, London, UK) endotracheally. As a result, his oxygenation index reduced stepwise to 2.6, the FiO2 requirement decreased to 0.4, and chest X-rays revealed better aeration (Figure 2B).