PMC9072841_01
Serial portable chest radiographs of the patient. (A) Hospital day 1 (day 8 after the symptom onset). (B) Hospital day 8. (C) Hospital day 14 (ECMO day 1). (D) Hospital day 23 (ECMO day 10) - right hemothorax with left shift of mediastinum were noted and (E) after insertion of a percutaneous drainage tube to the right pleural space.
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Chest radiography demonstrated ground glass opacities at lower lung fields (Fig. 1). On hospital day 8, he developed profound hypoxemia, and a chest radiograph revealed progression in patchy opacities at both lungs (Fig. 1). Chest radiograph showed a large right pleural effusion with a left shift of mediastinum (Fig. 1) suspicious for tension hemothorax.
Levels of serum inflammatory markers, absolute lymphocyte count, d-dimer, and fibrinogen of the patient along the course of treatment; ALC: absolute lymphocyte count; ARDS: acute respiratory distress syndrome; CRP: c-reactive protein; ECMO: extracorporeal membrane oxygenation; ETT: endotracheal tube; FEU: fibrinogen-equivalent units; IL-6: interleukin-6; PE: pulmonary embolism.
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Initial blood tests showed an absolute lymphocyte count of 1579/mm3, lactate dehydrogenase (LDH) of 234 U/L, and D-dimer of 545 ng/mL (Fig. 2). Decreased serum inflammatory markers and increased absolute lymphocyte counts were noted following days (Fig. 2).
Clinical course of the patient and treatment received in the intensive care unit; PF-PaO2/FiO2; PIP: peak inspiratory pressure; VCV: volume control ventilation; PCV: pressure control ventilation; PSV: pressure support ventilation; ETT: endotracheal tube; PEEP: positive end expiratory pressure; RR: respiratory rate; vv-ECMO: veno-venous extracorporeal membrane oxygenation; TV: tidal volume.
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He was intubated, and the mechanical ventilator was initially set on volume control ventilation (VCV), with a tidal volume (TV) of 6 mL/kg predicted body weight, positive end-expiratory pressure (PEEP) of 15 cmH2O, RR of 18 breaths/min, and FiO2 of 0.5 (Fig. 3). Owing to the failure of lung-protective ventilation, prone positioning was employed (Fig. 3). Given the progressive deterioration of oxygenation despite prone positioning (Fig. 3) and the presence of right ventricular dysfunction, venovenous extracorporeal membrane oxygenation (vv-ECMO) was initiated on hospital day 14.