Background: Double lumen intubation and one-lung ventilation should be applied without delay in cases of\ntraumatic main bronchial rupture. In most cases, when the patientsâ?? vital signs have been stabilized, the repair can\nbe performed. However, when one-lung ventilation is complicated by traumatic wet lung, the mortality rate is likely\nto be much higher.\nCase presentation: In this case, the patient experienced a left main bronchial rupture, bilateral traumatic wet lung,\nand acute respiratory distress syndrome (ARDS) because of severe thoracic trauma. Though the patient was treated\nwith intubation and mechanical ventilation (MV), his oxygenation was still not stable. Thus, veno-venous\nextracorporeal membrane oxygenation (V-V ECMO) was initiated; upon improvement of oxygenation, the patient\nreceived an exploratory thoracotomy. Unfortunately, the rupture proved to be irreparable, resulting in a total left\npneumonectomy. As there was severe ARDS caused by trauma, ECMO and ultra-low tidal volume (VT) MV strategy\n(3 ml/kg) were utilized for lung protection post-op. ECMO was sustained up to the 10th day, and MV until the 20th\nday, post-operation. With the support of MV, ECMO and other comprehensive measures, the patient made a\nrecovery.\nConclusion: V-V ECMO and ultra-low VT MV helped this thoracic trauma patient survive the lung edema period and\nprevented ventilator associated pneumonia (VAP). In extreme situations, with the support of ECMO, the tidal\nvolume may be lowered to 3 ml/kg.
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