Combination of airway pressure release ventilation and furosemide-induced metabolic alkalosis in a pediatric patient with severe acute respiratory distress syndrome: A case report

Lung protective strategy is widely accepted in ventilator management for acute respiratory distress syndrome (ARDS). In addition to ventilator-induced lung injury, care must be taken to prevent patient self-inflicted lung injury while preserving the patient’s spontaneous breathing. We propose a new concept that furosemide-induced metabolic alkalosis may play a pulmonary protective role in ventilator management for ARDS. We present a pediatric patient with severe ARDS who was successfully treated with a combination of airway pressure release ventilation (APRV) and furosemide administration. The patient’s spontaneous breathing effort was reduced during APRV due to metabolic alkalosis and PaCO₂ remained over 60 mmHg while pH was maintained around 7.4.