Prone positioning for ARDS following blunt chest trauma in late pregnancy

Abstract

After a road traffic accident a pregnant patient at 34 weeks of gestation developed ARDS following blunt chest trauma, for which she required mechanical ventilation. Twenty-four hours after the accident, ongoing severe hypoxaemia with atelectasis mainly in the dorsal parts of the lung led to the decision to manage the patient in the prone position. Prone positioning over 8 h resulted in a persistent improvement of oxygenation, which allowed extubation the following day. At term, however, our patient was admitted with dyspnoea, chest pain, haemodynamic instability and fetal bradycardia, for which she required emergency caesarean section followed by thoracotomy for haemothorax, from which she eventually made a full recovery. We have demonstrated that prone positioning can be used safely and effectively in a pregnant patient. It might be superior to other therapeutic options for improvement of oxygenation in pregnant patients. Careful positioning avoiding any external abdominal pressure and continuous fetal monitoring are mandatory.