Innovative use of EIT-guided prone positioning and inhaled nitric oxide therapy for refractory hypoxemia in primary graft dysfunction: a case report

Primary graft dysfunction Grade 3 (PGD 3) following lung transplantation significantly increases the incidence of acute and chronic complications. These effects complicate clinical perioperative management and significantly increase mortality. Here, we report a case of PGD 3 and refractory hypoxemia after bilateral lung transplantation at our center. Despite ongoing extracorporeal membrane oxygenation (ECMO) support, the patient's partial pressure of oxygen (PaO₂) remained suboptimal at 71.7 mmHg on postoperative day 4, precluding safe discontinuation of ECMO support. Consequently, EIT-guided interventions-including prone positioning optimization and inhaled nitric oxide (iNO) therapy-were implemented to improve oxygenation. After undergoing a rigorous treatment process, the patient was successfully weaned off ECMO on the 10th day and transitioned out of the intensive care unit (ICU) on the 24th postoperative day. The combination of prone positioning and iNO therapy, tailored through EIT-guided interventions, provided an innovative approach to post-lung transplant management and had the potential to save patients' lives.