Introduction: Lung protective ventilation therapy with low tidal volume-high\nPEEP is the standard treatment for the patients with acute respiratory distress\nsyndrome (ARDS). Oscillators are occasionally used for salvage ventilation in\ncases where poor compliance restricts the use of traditional ventilation with\nARDS. In addition to ventilator therapy, prone positioning has been used to\nimprove oxygenation. We presented a challenging case of ARDS, which failed\nmedical management extracorporeal membrane oxygenation (ECMO) support\nand oscillatory ventilation. Prone positioning was initiated which improved\noxygenation, respiratory compliance and posterior atelectasis. Case presentation:\nA 41-year-old morbid obese female developed ARDS due to influenza\npneumonia. The patient remained hypoxic despite optimum medical and\nventilator management and required veno-venous extracorporeal membrane\noxygenation (VV ECMO). CT scan of the chest showed ARDS with posterior\nconsolidation. Despite ARDSnet ventilation support, antiviral therapy and\nECMO support, there was no clinical improvement. High frequency oscillatory\nventilation was initiated on ECMO day #13, which resulted in no respiratory\nimprovement over the next 5 days. On ECMO day #18, the patient was\nplaced on a Rotaprone�® bed Therapy, utilizing a proning strategy of 16 hours a\nday. The clinical improvements observed were resolving of the consolidation\non CXR, improvements in ventilatory parameters and decreased oxygen requirements.\nThe patient was successfully weaned off ECMO on POD#25 (8\ndays post prone bed). Conclusions: Prone position improved oxygen saturation\nand pulmonary compliance in severe ARDS requiring ECMO and it might\nfacilitate early weaning.
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