Whole-process respiratory management strategies based on electrical impedance tomography in a pregnant woman with diffuse alveolar hemorrhage induced by systemic lupus erythematosus under veno-venous extracorporeal membrane oxygenation

Electrical impedance tomography (EIT) as a bedside, noninvasive, radiation-free technology, could quantify alveolar collapse and over-distension and provide real-time ventilation images of lungs. Clinical studies have shown potential benefit in reducing lung injury by EIT to guide mechanical ventilation setting in acute respiratory distress syndrome (ARDS). The respiratory management of ARDS with venous-venous extracorporeal membrane oxygenation (VV ECMO) remains a challenge for ICU doctors. Moreover, EIT has gained great interests in the respiratory management in VV ECMO therapy. Here, EIT was used for respiratory management in the presented case of a 36-year-old gravida with systemic lupus erythematosus, who developed severe hypoxia caused by diffuse alveolar hemorrhage. Although the patient received mechanical ventilation, VV ECMO was further used for the refractory respiratory failure. EIT was applied to titrate positive end-expiratory pressure (PEEP), guide prone position and early mobilization, dynamic evaluating lung development during ECMO therapy. She was successfully rescued after comprehensive therapy. In summary, an EIT-guided whole-process respiratory management strategy that included PEEP titration, prone position, early mobilization, and dynamic lung ventilation monitoring was proposed. This case demonstrated that EIT-guided whole-process respiratory management strategy was feasible in the respiratory failure patient with VV ECMO therapy.