Lung transplantation represents the most definitive treatment option for patients with advanced-stage lung diseases. In recent years, improvements in anesthetic techniques, medical technologies, and coordinated perioperative care have contributed to better survival outcomes.

A 37-year-old male patient with a height of 168 centimeters and a weight of 70 kilograms, diagnosed with cystic fibrosis, was scheduled for bilateral lung transplantation. Shortly after transitioning to single-lung ventilation, a rapid and severe increase in carbon dioxide levels was observed, reaching 136 mm Hg, accompanied by a decrease in blood pH to 7.0, indicating pronounced respiratory acidosis. In response, flow-controlled ventilation was applied for 6 hours during the eleven-hour surgical procedure.

Although the patient’s respiratory profile initially suggested the need for extracorporeal membrane oxygenation, the application of flow-controlled ventilation appeared to improve carbon dioxide elimination and may have reduced the risk of complications related to extracorporeal support. This case indicates that flow-controlled ventilation could be considered a supportive ventilation strategy to avoid extracorporeal membrane oxygenation in selected patients undergoing lung transplantation who develop isolated intraoperative respiratory insufficiency.