Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID-19 Patient With Control Cesarean Section

Eduardo E Chang,Marcos Cordoba,Esther Segura,Anup Kumar Trikannad Ashwini Kumar,Sruthi Vellanki

doi:10.7759/cureus.22660

Abstract

We share our experience of one 29-year-old female, G2 P1, with acute respiratory distress syndrome (ARDS) and at 30 weeks of pregnancy. The 30-week gravid uterus in combination with a poor ventilation-perfusion ratio creates a restrictive lung pattern that may prove to be lethal for both the mother and baby. Due to her rapid deterioration and increased hemodynamic instability we opted for controlled delivery in the operating room with an ICU physician, a Neonatologist, and an Obstetric team. At 3.27 minutes from induction, the baby was born with Apgar scores of 7 and 8. The mother was placed on a RotoProne® bed, treated with remdesivir, steroids, and was subsequently extubated seven days later. The newborn was admitted to the Neonatal Intensive Care Unit (NICU) after delivery. We have reviewed the literature and provided a concise set of recommendations based on our field experience and current world literature review. Prompt delivery in a controlled environment with multiple resuscitating teams provided expeditious treatment of both patients, maintaining oxygenation and perfusion while keeping hemodynamic stability. The controlled environment and the proximity of all teams avoided deleterious consequences to the unborn baby. This is an example where the risk of keeping the baby in the womb outweighs the premature delivery into a NICU. Both mother and baby were downgraded from their respective Intensive Care Units (ICUs) and discharged home in one month.

Highlights

Acute respiratory distress syndrome (ARDS) is a severe presentation of acute hypoxic respiratory failure
We share our experience of one 29-year-old female, G2 P1, with acute respiratory distress syndrome (ARDS) and at 30 weeks of pregnancy
The newborn was admitted to the Neonatal Intensive Care Unit (NICU) after delivery

Summary

Introduction

Acute respiratory distress syndrome (ARDS) is a severe presentation of acute hypoxic respiratory failure. The Delta variant (B.1.617.2 ) has been been reported to have increased morbidity among pregnant women with COVID-19, in areas where vaccination rates have been low The proportion of these cases is rising, and the severity of variant B.1.617.2 in pregnancy is unclear [5]. How to cite this article Chang E E, Cordoba M, Vellanki S, et al (February 27, 2022) Critical Care Management of a Severe Acute Respiratory Distress Syndrome COVID19 Patient With Control Cesarean Section. Premature delivery was planned due to continued deterioration despite high flow and noninvasive ventilation, the mother’s arterial oxygen content decreased in the 60% range. The mother was successfully weaned and extubated about one week later Post extubation, she required high flow oxygen with noninvasive ventilation. Both mother and baby survived this experience without any further complications while in the hospital and were where discharged home

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