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EXTRACORPOREAL MEMBRANE OXYGENATION APPLICATION IN PREGNANT PATIENT WITH UROSEPSIS ASSOCIATED ACUTE RESPIRATORY DISTRESS SYNDROME – A CASE REPORT

Background and Aims: Acute Respiratory Distress Syndrome (ARDS) is an uncommon condition during pregnancy. The common causes of ARDS during pregnancy are sepsis from pulmonary or nonpulmonary aetiologies, amniotic fluid embolism, preeclampsia, complications from tocolytic therapy, major trauma, transfusion with multiple-unit blood products, and aspiration of gastric content. Methods: We report a case of a 19-year-old woman, primipara, with pregnancy 21+2 weeks, who was admitted due to urosepsis with progression to ARDS. The diagnosis was supported by urine culture with Escherichia coli without pathogen yielded from sputum and bronchial lavage. And high-resolution computed tomography revealed bilateral symmetrical consolidation. Results: Transient fetal heart rate decrease noted during admission and hypoxemic respiratory failure developed on the next day. In spite of the application of lung protective ventilation with high level of positive end-expiratory pressure (PEEP) up to 16 mmHg and adequate sedation, refractory hypoxemia (PaO2: 78.5 mmHg, FiO2: 100%, PaO2/FiO2: 78.5) persisted still. Extracorporeal membrane oxygenation (ECMO) was then applied, and arterial oxygenation improved gradually. ECMO was removed four days later and then she was extubated on the next day. She was discharged with pregnancy 23+2 weeks, without other organs failure. Conclusion: According to reported studies and our case’s experience, extracorporeal life support may be beneficial in the management of the pregnant patient with severe ARDS. AP154