Prolonged Flow-Controlled Ventilation in a Patient With ARDS and Multiple Trauma

Flow-controlled ventilation (FCV) is characterized by a bidirectional linearized gas flow translating into a constant flow. We report the prolonged use of FCV in a 30-year-old patient with major trauma, including severe traumatic brain injury and posttraumatic ARDS, because the patient sustained other severe injuries such as those to the spine and pelvis. Conventional mechanical ventilation failed to attain normoxia and normocapnia, leading to hemodynamic compromise and refractory intracranial hypertension. FCV was used as an off-label rescue therapy because prone positioning and extracorporeal membrane oxygenation were contraindicated. Within a few hours, ventilation improved despite lower minute volumes. This was paralleled by a reduction in norepinephrine requirements and normalization of intracranial pressure. FCV was continued for 96 hours. This case report underlines the potential benefits of FCV as a novel ventilation mode in patients with ARDS and justifies future studies evaluating the outcome effects of FCV in this complex population.