title: Acute ischemic optic neuropathy with extended prone position ventilation in a lung transplant recipient.
abstract: Prone position ventilation (PPV) improves mortality in severe acute respiratory distress syndrome (ARDS), but outcomes following its use in lung transplant recipients are not known. We report the case of a 42-year-old Caucasian man who presented with severe ARDS from Bordetella pertussis, 5 years after bilateral sequential lung transplant for cystic fibrosis. He was managed with PPV for 22 days and had a prolonged ICU stay complicated by hypoxic ischemic optic neuropathy leading to blindness. Since his discharge from the ICU 6 months ago, his FEV1 has recovered to 47% predicted compared to his pre-ICU peak FEV1 of 85% predicted, suggesting recovery of lung function. This is the first report of optic nerve damage and vision loss in patients undergoing PPV. Our report also suggests that, in appropriately selected lung transplant recipients, severe hypoxemia could potentially be managed with prone ventilation.
authors.affiliation: Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
authors.forename: Tanmay S
authors.initials: TS
authors.lastname: Panchabhai
authors.affiliation: Department of Thoracic Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Bandyopadhyay
authors.affiliation: Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Aanchal
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Olufemi
authors.initials: O
authors.lastname: Akindipe
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Lane
authors.affiliation: Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Krishnan
keywords: ARDS; complications of prone position ventilation; lung transplantation; rescue modes of mechanical ventilation; severe hypoxemia