US EPA

2263007 

Journal Article 

Abstract 

Acute respiratory distress syndrome due to H1N1 influenza can be safely treated with inhaled nitric oxide in a pregnant patient 

Chacey, M; Mccallister, JW 

2010 

Yes 

American Journal of Respiratory and Critical Care Medicine
ISSN: 1073-449X
EISSN: 1535-4970 

181 

A6130 

English 

10.1164/ajrccm-conference.2010.181.1_MeetingAbstracts.A6130 

WOS:000208771004489 

is part of a larger document 3452678 Proceedings of the American Thoracic Society 2010 International Conference, May 14-19, 2010, New Orleans

Introduction: The H1N1 influenza A (H1N1) epidemic has led to an increase in patients in intensive care units (ICUs)with Acute Respiratory Distress Syndrome (ARDS). Alternative modalities for oxygen delivery and ventilation have been utilized, but limited data exists on their effectiveness in pregnant patients. We describe a case of H1N1 induced ARDS successfully treated with use of inhaled nitric oxide.

Case Presentation: The patient is a 20 year old female who presented at 29 weeks gestation during her first pregnancy to the emergency room complaining of three days of fevers, muscle aches, fatigue, and cough. The patient reported that both her husband and a coworker have recently been ill with flu like symptoms. Patient was admitted to labor and delivery, where she was treated for possible influenza with oseltamivir, pneumonia with ceftriaxone and azithromycin, and for asthma with albuterol. Shortly after admission, she developed worsening respiratory distress and hypoxemia. She was intubated and transferred to the ICU. Chest radiograph revealed a diffuse 5 lobe infiltrate. The patient required maximal levels of positive end expiratory pressure (PEEP) and oxygen to maintain oxygen saturations in the 90s secondary to refractory ARDS. Polymerase chain reaction (PCR) for H1N1 was positive. High doses of intravenous sedation were required due to ventilator dysynchrony, and eventually paralytic agents were started. Despite these interventions, the patient continued to have several episodes where her oxygen saturations decreased to the 80s and her partial pressure of oxygen (pO2) was at times as low as 52. Inhaled nitric oxide(iNO) was initiated and titrated up to 40 parts per million. The patient’s oxygen saturations stabilized and she was able to tolerate lower levels of PEEP and oxygen. After two days,the iNO was weaned to off, and gradually, the ventilator support was able to be decreased. The baby was delivered by caesarian section and did well. Following delivery, the mother was able to be weaned on the vent after delivery.

Discussion: Inhaled nitric oxide has been used with limited success in patients with ARDS for improving oxygenation and decreasing pulmonary vascular resistance, but no large studies are available to test its effectiveness in pregnancy. This case suggests that iNO can be used in pregnancy to improve oxygenation. With initiation of iNo, the patient’s oxygenation and hemodynamics stabilized, allowing for a safe and controlled caesarian section, with positive outcomes for both mother and child. 

American Thoracic Society 2010 International Conference 

New Orleans, LA 

May 14-19, 2010