68/M with ARDS

Case Presentation

A 68-year-old man with influenza-associated acute respiratory distress syndrome developed subcutaneous emphysema and pneumomediastinum 7 days after symptom onset while receiving high-flow nasal cannula therapy. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated, followed by lung-protective mechanical ventilation. Bronchoscopy showed no major tracheobronchial injury. On day 11, the patient developed impaired venous drainage and hypotension (systolic blood pressure <60 mmHg), requiring norepinephrine and vasopressin. Physical examination showed deteriorated palpable crepitus in the chest and neck. Chest computed tomography was performed to evaluate the cause of refractory hypotension, impaired ECMO drainage, and extensive subcutaneous emphysema.