Abstract
RATIONALE: Prone position ventilation (PPV) has been shown to improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome; however, its use in patients with contraindications to the prone position is challenging. Additionally, patients who undergo PPV after laparotomy are often associated with gastrointestinal dysfunction. Therefore, early enteral nutrition is crucial, but effective bedside tube placement techniques are currently lacking in clinical practice. PATIENT CONCERNS: A 57-year-old male patient developed acute respiratory distress syndrome and pelvic fractures without internal fixation after multiple injuries. He had contraindications to PPV and experienced gastrointestinal dysfunction and enteral nutrition issues following laparotomy. Traditional methods cannot address both problems at the same time. DIAGNOSES: The primary diagnoses include multiple trauma, complex intra-abdominal infection, pulmonary contusion, multiple rib fractures, pelvic fractures, and septic shock. INTERVENTIONS: The medical team used a burn rotation bed for PPV and employed magnetic navigation technology to guide the placement of a double-lumen nasoenteric tube for enteral nutrition. OUTCOMES: The patient's oxygenation improved, with smooth sputum drainage and reduced pulmonary inflammation. Gastrointestinal function was restored, and enteral nutrition was successfully initiated. Subsequently, the patient underwent successful pelvic fixation surgery and was transferred out of the intensive care unit. The patient was eventually discharged and continued to be followed up as an outpatient. LESSONS: This case demonstrates the feasibility of implementing PPV and nutritional support despite contraindications through careful clinical decision-making, which involves weighing the risks and benefits, and offers valuable clinical experience for similar cases.