Nursing care planning in a patient with severe acute respiratory distress syndrome treated with venovenous extracorporeal membrane oxygenation: A case report.

ASSESSMENT: Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure characterized by severe hypoxemia, reduced lung compliance, and bilateral pulmonary opacities not fully explained by cardiogenic causes. We report a case of severe refractory ARDS in the immediate postoperative period following urgent abdominal surgery in a patient with extreme obesity, focusing on nursing assessment and care planning during venovenous extracorporeal membrane oxygenation (VV-ECMO) support. A 47-year-old woman (BMI 71.11 kg/m2) developed severe ARDS (PaO2/FiO2 60 mmHg) after aspiration during anesthetic induction, refractory to advanced ventilatory strategies (PEEP 15 cm H2O and prone positioning), and underwent jugulo-jugular VV-ECMO cannulation. The clinical course was favorable, with decannulation on day 5, extubation on day 11, and ICU discharge on day 13 without relevant respiratory sequelae.

DIAGNOSES: Seven NANDA-I nursing diagnoses were prioritized: impaired gas exchange (00030), impaired spontaneous ventilation (00033), risk for infection (00004), risk for impaired skin integrity (00047), risk for impaired physical mobility (00324), acute pain (00132), and obesity (00232).

PLANNING: NOC outcomes and NIC interventions were established, and baseline outcome scores (RO) were recorded using a Likert scale. An AREA clinical reasoning network was developed to analyze diagnostic interconnections and support prioritization.

DISCUSSION: VV-ECMO is an effective therapy for refractory hypoxemia in severe ARDS when delivered in experienced centers, enabling ultraprotective ventilation and serving as a bridge to recovery. Standardized NANDA-NOC-NIC language supports the organization and evaluation of the care plan in highly complex, critically ill patients, including those with extreme obesity. This case illustrates the role of structured nursing care planning in VV-ECMO patients with extreme obesity.