Bilateral lung transplantation during pregnancy after ECMO for influenza-A caused ARDS

“…Among the most common causes for peripartum ICU admissions are exacerbation of a pregnancy-related condition, such as hypertensive pregnancy disorders, preeclampsia, eclampsia, and HELLP-syndrome, followed by hemodynamic instability, postpartum hemorrhage (PPH), and maternal sepsis [ 1 , 7 , 8 , 9 ]. Non-pregnancy related conditions include exacerbations of pre-existing maternal diseases, such as hypertension, diabetes mellitus, bronchial asthma, congenital cardiac defects, rheumatic diseases, and viral infections such as influenza or coronavirus disease (COVID-19) [ 3 , 10 , 11 ]. With regard to the latter, it is known that pregnant women with COVID-19 are more likely to be admitted to the ICU and suffer from severe morbidity than non-pregnant women [ 7 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria

Foessleitner,

Budil,

Mayer

et al. 2023

JCM

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Peripartum maternal admission to the intensive care unit is challenging for anesthesiologists, obstetricians, and all personnel involved. An understanding of altered maternal physiology, fetal considerations, and acute peripartum emergencies is required to ensure adequate maternal and neonatal outcomes. In this study, we analyzed data of peripartum maternal admissions to the intensive care unit at our large tertiary referral center in order to define trends and changes over time. This study retrospectively analyzed maternal morbidity, admission diagnoses, treatments, and outcomes of women with peripartum admission to the intensive care unit at our tertiary care center over a 15-year period. We found that patient characteristics and admission diagnoses remained remarkably consistent over the observational period; however, there was a significant increase in postpartum hemorrhage (r = 0.200, p < 0.001) and cesarean hysterectomy (r = 0.117, p = 0.027) over time. Moreover, we found a reduction in preterm births (r = −0.154, p = 0.004) and a decreased peripartum neonatal intensive care unit admission rate (r = −0.153, p = 0.006) among women who were transferred to the intensive care unit. Based on our long-term observational data, there is consistent need for intensive care in obstetrics due to a small number of different etiologies. Specialized training for the predominant diagnoses involved as well as multidisciplinary care of the affected patients are both warranted.

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Multiple drugs

2021

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Multiple drugsWithdrawal symptoms and lack of efficacy: case report A male neonate [age not stated] developed withdrawal symptoms following in-utero exposure to quetiapine, gabapentin and lorazepam. He also exhibited lack of efficacy during treatment with hydrocortisone, nitric oxide, iloprost, sildenafil, epinephrine, norepinephrine and vasopressin in treatment of pulmonary hypertension [dosages not stated] [not all routes stated] [parent routes of administration not stated].The mother, who was primipara, presented to the hospital with acute respiratory distress syndrome (ARDS) caused by influenza-A-induced pneumonia, at 16 +5 gestational weeks. Due to irreversible lung damage, she underwent bilateral lung transplantation. Following transplantation, she started receiving immunosuppressive treatment with alemtuzumab, tacrolimus and unspecified steroids. She also received sedative and analgesic medications, which included quetiapine, gabapentin and lorazepam. Her posttransplant recovery was uneventful. On post-operative day 88, at 29 +3 gestational weeks, a Doppler scan of the umbilical artery showed zero flow with intermittent reverse flow. She was elected for a caesarean section. At 29 +5 gestational weeks, she was administered magnesium sulfate for fetal neuroprotection. A male neonate was delivered via caesarean section with an Apgar scores at 1, 5 and 10 min of 8, 9, and 9 and weight of 800g. After birth, he was transferred to the neonatal ICU. He had severe ARDS and received cardiorespiratory support by nasal continuous positive airway pressure (CPAP). After 25min of life, less invasive surfactant administration was performed. Subsequently, he developed withdrawal symptoms due to in-utero exposure to high levels of quetiapine, gabapentin and lorazepam. This resulted in the need of sedatives after birth. He was intubated and mechanically ventilated. He started receiving hydrocortisone for decreasing blood pressure. Echocardiography showed pulmonary hypertension. He started receiving inhaled nitric oxide, iloprost and sildenafil for pulmonary hypertension. He also started receiving norepinephrine [noradrenalin], epinephrine [adrenalin] and vasopressin for 2 days for arterial hypotension. He received thrombocyte concentrates for severe thrombocytopenia. However, he suffered from frequent, severe hypoxic events and pulmonary hypertension episodes (lack of efficacy). On postpartum day 5, despite the intensive care approach, the neonate died. Autopsy was performed and post-mortem histological examination confirmed persistent pulmonary hypertension as the cause of death [not all durations of treatments to reaction onset stated].

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Bilateral lung transplantation during pregnancy after ECMO for influenza-A caused ARDS

Cited by 4 publications

References 31 publications

Pregnancy and pulmonary hypertension in the pre-lung transplant patient: Successfully saving two lives with extracorporeal lung support

Pregnancy and pulmonary hypertension in the pre-lung transplant patient: Successfully saving two lives with extracorporeal lung support

Peripartum Maternal Admission to the Intensive Care Unit: An Observational Study over a 15-Year Period at a Tertiary Center in Austria

Multiple drugs

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