背景。孕妇患2019年冠状病毒病(COVID-19)并发症的风险很高,包括急性呼吸窘迫综合征.目前,治疗这种情况的基石之一是低潮气量的肺保护性通气(LPV)。然而,高碳酸血症的发生可能会限制这种通气策略。所以,已经开发了不同的体外CO2去除(ECCO2R)程序。ECCO2R包括多种技术,包括低流量和高流量系统,可以使用专用设备或与连续肾脏替代疗法(CRRT)结合进行。案例描述。这里,我们报告了1例妊娠患者受COVID-19影响,需要体外支持治疗多器官功能衰竭.而在LPV上,因为伴随的高碳酸血症和急性肾损伤,患者接受了在CRRT平台的血液过滤器后串联插入ECCO2R膜的治疗.这种减少高碳酸血症的联合治疗允许同时维持LPV,同时提供肾脏替代并确保母体和胎儿血液动力学稳定性。不良反应包括由于维持体外回路通畅所需的抗凝作用而引起的轻微出血事件。患者的肺和肾功能逐渐恢复,允许撤回任何体外治疗。在第25孕周,由于胎盘早剥,患者接受了自发性阴道早产。她生下了一个800克的女婴,三天后死于与极度早产有关的多器官衰竭。Conclusions.此案例支持使用ECCO2R-CRRT联合治疗作为复杂条件管理的合适方法,比如怀孕,即使在严重的COVID-19的情况下。
Background. Pregnant women are at high risk of Coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome. Currently, one of the cornerstones in the treatment of this condition is lung-protective ventilation (LPV) with low tidal volumes. However, the occurrence of hypercapnia may limit this ventilatory strategy. So, different extracorporeal CO2 removal (ECCO2R) procedures have been developed. ECCO2R comprises a variety of techniques, including low-flow and high-flow systems, that may be performed with dedicated devices or combined with continuous renal replacement therapy (CRRT).
Case description. Here, we report a unique
case of a pregnant patient affected by COVID-19 who required extracorporeal support for multiorgan failure. While on LPV, because of the concomitant hypercapnia and acute kidney injury, the patient was treated with an ECCO2R membrane inserted in series after a hemofilter in a CRRT platform. This combined treatment reducing hypercapnia allowed LPV maintenance at the same time while providing kidney replacement and ensuring maternal and fetal hemodynamic stability. Adverse effects consisted of minor bleeding episodes due to the anticoagulation required to maintain the extracorporeal circuit patency. The patient\'s pulmonary and kidney function progressively recovered, permitting the withdrawal of any extracorporeal treatment. At the 25th gestational week, the patient underwent spontaneous premature vaginal delivery because of placental abruption. She gave birth to an 800-gram female baby, who three days later died because of multiorgan failure related to extreme prematurity. Conclusions. This
case supports using ECCO2R-CRRT combined treatment as a suitable approach in the management of complex conditions, such as pregnancy, even in the
case of severe COVID-19.