Fig. 5

a. Day 1, admission in the local hospital. b. The patient was intubated and ventilated with PCV on day 2. c. The sputum culture yielded MRSA on day 4. d. Complicating with right pneumothorax, the patient accepted VV-ECMO to maintain oxygenation and transferred to our RICU for further support. HFOV, prone position and PSV with protective strategy were used for promoting lung recovery and removal of secretion. e. On day 13, insufficient vancomycin drug concentration urge the change to linezolid. The chest tube was also pulled out on this day. f. Nosocomial Acinetobacter baumannii infection was detected, tigecycline was used for strengthening the antibiotic therapy on day 17. g. VV-ECMO was weaned on day 19. h. The patient was extubated on day 25. i. Cefoperazone/sulbactam was used for extensive drug resistant Acinetobacter baumannii infection on day 30. j. Candida albicans infection was detected, itraconazole was added. k. The patient was discharged home on day 48. Vancomycin and imipenem: Day 6–12; voriconazole: Day 6–20; linezolid: day 13–48; tigecycline: day 17–39; cefoperazone:day 30–42; itraconazole: day 43–48. Abbreviations: MRSA, methicillin resistant Staphylococcus aureus; ECMO, extracorporeal membrane oxygenation; HFNC, high flow nasal catheter; HFOV, high frequency oscillatory ventilation; PSV, pressure support ventilation; PCV, pressure control ventilation