Successful management of atypical pneumonia in acute respiratory distress syndrome patient during pregnancy
Taiwanese Journal of Obstetrics & Gynecology
Atypical pneumonia can be caused by special bacteria, viruses, fungi, and protozoa. It may progress to lobar pneumonia and turn to acute respiratory distress syndrome (ARDS). Treatment of ARDS in pregnant women is particularly challenging because of the high risk of death for both the mother and the fetus. In the cases of refractory impairment of gas exchanges unresponsive to conventional measures, intubation with oxygen supplement is necessary. When caring for a critically ill pregnant woman,
... he most critical issue is the appropriate time for delivery. We report the management of atypical pneumonia using mechanical ventilation during the second trimester without complications. A 28-year-old woman (gravida 1, para 0) presented at gestational age 24 weeks and 3 days at the outpatient Department of Obstetrics. She had been ill for 1 week, and demonstrated a nonproductive cough, mild fever with body temperature of 37.6 C, dyspnea, and increased respiratory frequency. The past history was unremarkable, and her prenatal examination was normal. She had orthopnea and tachycardia with a white blood cell count of 16.5 Â 10 9 /L, hemoglobin 10.1 g/dL, mean corpuscular volume 92.7 fL, C-reactive protein 3.0 mg/dL, neutrophils 80.7%, and lymphocytes 13.3%. Capillary oxygen saturation was 89% at admission. Oxygen mask with venturi (nonrebreathing bag to achieve high oxygen fraction of near 100%) was given but the patient still progressed to respiratory distress. Her chest x-ray showed pulmonary infiltration over bilateral lower lungs. Blood gas analysis showed severe hypoxemia and mild alkalosis (pH 7.494, PO 2 63.9, PCO 2 35.9, HCO 3 27, oxygen saturation 93.0%) was diagnosed. She was transferred to the intensive care unit with a presumptive diagnosis of atypical pneumonia and ARDS. A follow-up chest x-ray showed extensive, bilateral lobar consolidation (Figure 1 ). Emergent intubation was performed under intravenous anesthesia, ventilated with a tidal volume of 8 mL/kg ideal body weight, a respiratory rate of 40 breaths/min, and a positive end-expiratory pressure of 6e8 cmH 2 O. Her consciousness was still clear post intubation on the 2 nd day and respiratory function deteriorated progressively despite treatment. Extracorporeal membrane oxygenation therapy was Figure 1 . Chest radiography. Alveolar infiltration of whole lobes with pulmonary congestion.