PDF(Pubmed)
Abstract：
Acute respiratory syndrome caused by a novel coronavirus (SARS-CoV-2) in pregnant women can progress to a critical condition. In this paper, we present a case of a woman in the 28th week of gestation hospitalized due to respiratory insufficiency caused by COVID-19 infection and consequent bilateral pneumonia with development of severe acute respiratory distress syndrome. Noninvasive ventilation through a face mask was started but due to progression of respiratory insufficiency with high FiO2 and positive end expiratory pressure (PEEP), we decided to intubate the patient, after which obstetricians agreed to complete pregnancy by cesarean section. The clinical course was complicated by desaturation and bradycardia with recurring asystole which recovered after the use of atropine. The patient was increasingly difficult to mechanically ventilate on the PSIMV modality (tidal volume [TV] <200 mL). She was switched to ASV modality (TV up to a maximum of 350 mL, ASV 130%, PEEP 16 cm H2O, FiO2 100%, RR 25/min, pPeak 35 cm H2O, pPlateau 35 cm H2O), after which peripheral saturation recovered to 89%. Due to inadequate mechanical ventilation, the patient was transferred to Dr. Fran Mihaljević University Hospital for Infectious Diseases in order to perform extracorporeal membrane oxygenation (ECMO). Owing to all of the measures taken, recovery followed after 13 days on ECMO.
摘要：
孕妇中由新型冠状病毒（SARS-CoV-2）引起的急性呼吸道综合症可能会发展到危急状态。在本文中,我们介绍了一例妊娠28周时因COVID-19感染引起的呼吸功能不全和随后的双侧肺炎而住院的妇女,并发展为严重的急性呼吸窘迫综合征.开始通过面罩进行无创通气，但由于高FiO2和呼气末正压（PEEP）的呼吸功能不全的进展，我们决定给病人插管,之后，产科医生同意通过剖宫产完成妊娠。临床过程因使用阿托品后恢复的去饱和和心动过缓以及复发性心搏停止而复杂化。患者在PSIMV模式下机械通气越来越困难（潮气量[TV]<200mL）。她被切换到ASV模式(电视最高可达350毫升，ASV130%,PEEP16cmH2O,FiO2100%,RR25/min,pPeak35cmH2O,pPlateau35cmH2O),之后外周饱和度恢复到89%。由于机械通气不足，患者被转到FranMihaljević大学传染病医院进行体外膜氧合(ECMO).由于采取了所有措施，ECMO13天后恢复。
