Abstract We present the case of a young woman with morbid obesity who developed severe acute respiratory distress syndrome associated with influenza A H1N1 infection who, despite providing volume-controlled ventilation strategies, PEEP 12 cmH2O, tidal volume of 8 ml/kg of predicted body weight and sedation for RASS -3, persisted with refractory hypoxemia and permissive hypercapnia off targets. As stabilization therapy, the initiated veno-venous hemodiafiltration continued with extracorporeal carbon dioxide removal and cycles of at least 24 hours of prone positioning while awaiting referral to extracorporeal membrane oxygenation. Influenzavirus A subtype H1N1 has single-stranded RNA and displays on its surface two essential glycoproteins Hemagglutinin (cell adhesion) and Neuraminidase (release of new virions) that, due to a dysregulated response of cytokines and proinflammatory factors coupled with increased viral replication, induce greater lung injury and risk of progression to severe Acute Respiratory Distress Syndrome. This medical condition continues to be a challenge for health personnel, with special difficulty in patients with conditions such as morbid obesity, where physiological parameters and ventilatory strategies may have significant variations. Given the severity of the cases and the lack of immediate availability of extracorporeal membrane oxygenation, extracorporeal carbon dioxide removal may be an alternative for support and maintenance of protective ventilatory measures, as mentioned in the case below. This abstract is funded by: none
Perez et al. (Fri,) studied this question.