Abstract
SARS-CoV-2 enfeksiyonunda akciğer tutulumu olup hipoksemi gelişen olgularda oksijen desteği yanında prone pozisyon da uygulanmaktadır. COVID-19 enfeksiyonunda gebelerde gelişen hipoksemi anne ve bebekte morbidite ve mortaliye neden olabilmektedir. Bu sunuda COVID-19’a bağlı ARDS tanısıyla yoğun bakımda (YB) takip edilirken prone pozisyonu verdiğimiz gebe hastaların klinik sonuçlarını sunmayı amaçladık.
Yoğun bakımda COVID-19 tanılı 5 gebe hastaya prone pozisyon verildi. Hastalar ortalama 33.2± 6.41 yaşında, gebelik haftaları 24-28 arasında idi. Dört olgu invaziv mekanik ventilasyon (MV), 1 olgu yüksek akım nazal oksijen ve aralıklı noninvaziv MV uygulanarak takip edildi. Hastaların prone pozisyon öncesi PaO2/FiO2 (P/F) değerleri (57.9±14.8) ile prone pozisyonda 8. (122.8±41.7) ve 16. saatte (123.0±30.8) anlamlı olarak yükseldi (sırasıyla p=0.026, p=0.010). Prone pozisyona bağlı fetüs ve anne kaybı ile karşılaşılmadı. Tedavileri sonunda YB mortalitesi %60 (n=3) idi.
Prone pozisyon, gebelik anatomisi ve fizyolojisi dikkate alınarak gebelerde güvenle uygulanabilir. Karın bölgesinin bası altında kalmaması için pozisyon verilirken göğüs ve pelvis için destekler kullanılmalı. Gebelerde 24 haftadan sonra prone pozisyon sırasında PaO2, PCO2, hemodinamik veriler yanında fetal izlem de unutulmamalıdır.
Supporting Institution
Bursa Şehir Hastanesi
Project Number
2022-1/15 nolu
References
- 1. Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F Jr. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Rev Clin Pharmacol. 2021, 14(5), 601-621.
- 2. Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013, 188(11), 1286-93.
- 3. Samanta S, Samanta S,Wig J, Baronia AK. How safe is the prone position in acute respiratory distress syndrome at late pregnancy? Am J Emerg Med. 2014, 32(6), 687.
- 4. Huang CY, Tsai YL, Lin CK. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). J Obstet Gynecol 2021, 60(3), 574-576.
- 5. Donzell M, Ippolito M, Catalisano G, Renda B, Tarantino F, Diquattro O, Cortegiani A. Prone positioning and convalescent plasma therapy in a critically ill pregnant woman with COVID-19. Clin Case Rep. 2020, 8(12), 3352-3358.
- 6. Ray B, Trikha A. Prone position ventilation in pregnancy: Concerns and evidence. Journal of Obstetric Anaesthesia and Critical Care 2018, 8(1), 7.
- 7. Dunietz GL, Sever O, DeRowe A, Tauman R. Sleep position and breathing in late pregnancy and perinatal outcomes. J Clin Sleep Med. 2020, 16(6), 955– 959.
- 8. Wong MJ, Bharadwaj S, Lankford AS, Galey JL, Kodali BS. Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center. Int J Obstet Anesth. 2022, 49:103236.
- 9. Pourdowlat G, Mikaeilvand A, Eftekhariyazdi M, Nematshahi M, Ebrahimi M, Kazemzadeh A. Prone-Position Ventilation in a Pregnant Woman with Severe COVID-19 Infection Associated with Acute Respiratory Distress Syndrome. Tanaffos. 2020; 19(2), 152–155.
PEffects Of Prone Positioning In 5 Pregnant Patients With Low Oxygen Saturation Diagnosed With COVID-19
Abstract
Acute respiratory distress syndrome (ARDS) is a condition with severe hypoxemic respiratory failure. Hypoxemia in pregnant women may lead to morbidity and mortality in the mother and baby. The prone position is one of the treatment options. However, it is hesitant to apply this position to pregnant women. In this report, we aimed to present the clinical results of pregnant patients diagnosed with COVID-19-associated ARDS (CARDS) followed up in the prone position in the intensive care unit (ICU).
Five pregnant patients diagnosed with CARDS were placed in the prone position in the ICU. The patients were 33.2±6.41 years old, and their gestational weeks were between 24-28. Four cases were followed up with invasive mechanical ventilation (MV), one case with high-flow nasal oxygen and non-invasive MV. The PaO2/FiO2 (P/F) ratios of the patients were 57.9±14.8 in the pre-prone position but were significantly higher at the 8th (122.8±41.7) and 16th hours (123.0±30.8) of the prone position (p=0.026, p=0.010). There were no complications in the fetuses or mothers due to the prone position. ICU mortality was 60% (n=3).
The prone position can be safely applied in pregnant women even when considering the anatomy and physiology of pregnancy. Supports for the chest and pelvis should be used while positioning so that the abdominal region is not under pressure. Fetal monitoring should not be ignored, as well as the monitoring of the PaO2, PCO2, and hemodynamic parameters during the prone position after 24 weeks of pregnancy.
Project Number
2022-1/15 nolu
References
- 1. Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F Jr. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Rev Clin Pharmacol. 2021, 14(5), 601-621.
- 2. Gattinoni L, Taccone P, Carlesso E, Marini JJ. Prone position in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2013, 188(11), 1286-93.
- 3. Samanta S, Samanta S,Wig J, Baronia AK. How safe is the prone position in acute respiratory distress syndrome at late pregnancy? Am J Emerg Med. 2014, 32(6), 687.
- 4. Huang CY, Tsai YL, Lin CK. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). J Obstet Gynecol 2021, 60(3), 574-576.
- 5. Donzell M, Ippolito M, Catalisano G, Renda B, Tarantino F, Diquattro O, Cortegiani A. Prone positioning and convalescent plasma therapy in a critically ill pregnant woman with COVID-19. Clin Case Rep. 2020, 8(12), 3352-3358.
- 6. Ray B, Trikha A. Prone position ventilation in pregnancy: Concerns and evidence. Journal of Obstetric Anaesthesia and Critical Care 2018, 8(1), 7.
- 7. Dunietz GL, Sever O, DeRowe A, Tauman R. Sleep position and breathing in late pregnancy and perinatal outcomes. J Clin Sleep Med. 2020, 16(6), 955– 959.
- 8. Wong MJ, Bharadwaj S, Lankford AS, Galey JL, Kodali BS. Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center. Int J Obstet Anesth. 2022, 49:103236.
- 9. Pourdowlat G, Mikaeilvand A, Eftekhariyazdi M, Nematshahi M, Ebrahimi M, Kazemzadeh A. Prone-Position Ventilation in a Pregnant Woman with Severe COVID-19 Infection Associated with Acute Respiratory Distress Syndrome. Tanaffos. 2020; 19(2), 152–155.
Details
| Primary Language | English |
|---|---|
| Subjects | Intensive Care, Obstetrics and Gynaecology |
| Journal Section | Olgu Sunumu |
| Authors | |
| Project Number | 2022-1/15 nolu |
| Publication Date | June 27, 2025 |
| Submission Date | January 31, 2024 |
| Acceptance Date | December 2, 2024 |
| Published in Issue | Year 2025 Volume: 12 Issue: 2 |
