AKUT SOLUNUM YETMEZLİKLİ GEBEDE SEZARYEN VE YOĞUN BAKIM YÖNETİMİ

Year 2015, Volume: 4 Issue: 1, 51 - 54, 30.04.2012

Tamer Kuzucuoğlu Serkan Uçkun

Abstract

Bilinen sistemik hastalığı olmayan 39 yaşında 3. gebelik 35 haftalık bayan hasta, yüksek ateş, solunum sıkıntısı, iştahsızlık şikayetleriyle kadın doğum kliniği tarafından yatırıldı ve semptomatik tedaviye başlandı. Yatışının 4.günü genel durumun kötüleşmesi üzerine acil sezaryen operasyonuna alındı. Operasyonun 5. dakikasında APGAR: 9 (5.dk) canlı kız çocuğu doğurtuldu. Entübe olarak yoğun bakım ünitesine alınan hasta monitörize edildi. Kan, idrar, trakea kültürleri alınan hastanın hemogram, biyokimya ve kan gazları günde 2 kez değerlendirildi. ARDS gelişmesi üzerine FİO2: %80, PEEP: 12cmH2O, TV: 5ml/kg olarak MV parametreleri ayarlandı. Kan kültürlerinde gram negatif enterekok ve psödomonas üremesi üzerine meropenem 3x1, teicoplanin 3x1, linezolid 4x1 ve H1N1 şüphesi ile osaltamivir (2x75mg) başlandı. CRP, ateş ve lökositi normalleşen hastaya 4. günde fiberoptik bronkoskopi (FOB) yapıldı ve bronkoalveolar lavaj (BAL) alındı. Üreme görülmedi. Yatışının 6. gününe kadar ARDS destek tedavisine devam edilen hastada 8. günde “weaning” başlandı ve 9. günde ekstübe edildi. Yatışının 12. gününde vital bulguları stabil solunum ve dolaşım parametreleri normal olarak kadın doğum kliniğine transfer edildi.

Keywords

gebelik pnömonisi, sezaryen, solunum yetmezliği

MANAGEMENT OF CAESAREAN SECTIO AND INTENSIVE CARE UNIT PROCESS IN THE PREGNANT WITH ACUTE RESPIRATORY FAILURE

Abstract

The 39-year-old female patient without a known systemic disease who was pregnant to her third delivery in the 35th gestational week was admitted in the Clinic of Gynecology and Obstetrics due to high fever, dyspnea and appetite loss to initiate symptomatic treatment. In her 4th admission day, due to deterioration of her clinical symptoms, the patient was undergone an emergency caesarean section. In the fifth minute of operation, an alive female birth with APGAR Score 9 (at fifth min ) was delivered. The intubated patient was transferred to intensive care unit (ICU) and monitorized. Blood, urine, tracheal cultures of the patients were taken and complete blood count, biochemistry and blood gases were evaluated 2 times a day. ARDS developed and FiO2: 80%, PEEP: 12cmH 2O, TV: 5ml/kg parameters was administered. Since gram negative enterococci and pseudomonas grew in the blood cultures; administration of meropenem 3x1, teicoplanin and linezolid 4x1 were initiated and combined with oseltamivir (2x75mg) for suspicious H1N1. The patient with normalized CRP, fever and leukocyte count was performed flexible bronchoscopy in the 4th admission day and bronchoalveolar lavage (BAL) was obtained. No growth was observed. The supportive care for Adult Respiratuar Distres Syndrome (ARDS) was continued until 6th admission day and converted to weaning in the 8th admission day. She was extubated in the 9th day. She was transferred to Clinic of Gynecology and Obstetrics with normal respiratory and circulatory parameters and vital parameters stabil in the 12th admission day.

Keywords

pregnancy pneumonia, caesarean

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