ABSTRACT
OBJECTIVE: Few data are available on the ICU management and on the possible respiratory complications of invasively ventilated pregnant patients affected by COVID-19 pneumonia, especially in the early phase of pregnancy. Tension pneumothorax has been previously described as a rare cause of respiratory failure after delivery, but its occurrence in the postpartum of COVID-19 patient has not been reported yet. We hereby describe the ICU management of a 23rd gestational week pregnant woman who underwent invasive mechanical ventilation, prone positioning, and cesarean delivery during her ICU stay for COVID-19 related pneumonia. Moreover, we focused on the occurrence and management of recurrent tension pneumothorax after the cesarean delivery. CASE REPORT: A 23rd gestational week pregnant woman was admitted to the ICU for a COVID-19 bilateral pneumonia and underwent invasive mechanical ventilation and prone positioning. Cesarean delivery was planned during the ICU stay, while the patient was receiving invasive mechanical ventilation. After delivery, the patient experienced a recurrent pneumothorax that required the positioning of multiple chest drains. CONCLUSIONS: In pregnant critically ill COVID-19 patients, mechanical ventilation management is particularly challenging, especially in the postpartum period. Prone positioning is feasible and can improve oxygenation and respiratory system compliance, while tension pneumothorax must be suspected if the respiratory function suddenly deteriorates after delivery.
Subject(s)
COVID-19/complications , Cesarean Section , Critical Illness , Pneumothorax/etiology , Postoperative Complications/therapy , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Adult , COVID-19/diagnostic imaging , Female , Humans , Infant, Newborn , Postoperative Complications/diagnostic imaging , Pregnancy , Prone Position , Recurrence , Respiration, Artificial , Respiratory Distress Syndrome/diagnostic imaging , Treatment OutcomeABSTRACT
Background: Since February 2020, CoViD-19 spread in Italy. Acute respiratory failure (ARF) was the most relevant clinical presentation, often requiring invasive and non-invasive ventilation. We report the management of ARF in in-patients using Easy Vent Mask (EVM) system for C-PAP, a device registered for prehospital use. Methods: In this retrospective study, we included all patients admitted to Emergency Medicine Unit from March 2 to April 25, 2020 with ARF secondary to CoViD-19 pneumonia and treated with EVM system. Our aim was to evaluate the efficacy and tolerability of in-hospital use of EVM system. All demographic, clinical and treatment data were recorded. Results: Thirty patients affected by mild/moderate CoViD-19 pneumonia having PaO2/FiO2(P/F) ratio between 100 and 200 were treated with EVM system for C-PAP, of them 25(83%) were discharged and 5(17%) died in hospital. The system was well tolerated with a mean time of use of 13 consecutive days. Five patients were transferred to ICU due to failure of C-PAP treatment, of whom 3 died. Two patients died in our ward for worsening of clinical conditions. Pressure skin lesions and hypercapnia were recorded as adverse events in 24 and 2 patients respectively. Moreover, our finding showed a higher reduction of P/F value and a longer time from admission to C-PAP initiation in non-survivors, compared to survivor patients. Conclusions: EVM system for C-PAP seemed to be well tolerated and may represent an alternative to ventilators in in-hospital treatment of CoViD-19 mild/moderate pneumonia, but dedicated studies are needed.