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2016, Number 3

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Rev Mex Anest 2016; 39 (3)

Acute respiratory distress syndrome in puerperium

Viruez-Soto JA, Ibáñez-Velasco BR, Bailey-Rojas FB, Zavala-Barrios B, Briones-Garduño JC, Díaz de León-Ponce MA

Language: Spanish
References: 20
Page: 227-231
PDF size: 647.61 Kb.


ABSTRACT

Introduction: Immune tolerance and pregnancy changes associate to an increased risk of infection, including community pneumonia, influenza pneumonia and varicella zoster pneumonitis, sometimes also with acute respiratory distress syndrome. The objective is expose an acute respiratory distress syndrome case during puerperium, successfully discharged. Case report: 22 year-old patient, last partum 14 days before, admitted to Adult Critical Care Unit because of progressive dyspnea, hypoxemia and chest X-ray with bilateral opacifications disseminated mainly in basal posterior regions, obstetrical sepsis origin is ruled out, airway pressure release ventilation is performed in prone position, methylprednisolone administration and oseltamivir, at 72 hours oxygenation improves and at the 6th day is extubated, with vesicular eruption in intercostal layers. Discussion: During pregnancy a cellular immune suppression, protection associated to Th2 cytokines and HLA-G expression is found, the reversion of this situation during puerperium results in clinical manifestations of latent infections known as «immune reconstitution inflammatory syndrome», treatable with steroids. It becomes indispensable to consider dyspnea and hypoxemia causes during puerperium. The conduct assumed in this case avoided an indirect maternal death case.


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