AKUT SOLUNUM YETMEZLİKLİ GEBEDE SEZARYEN VE YOĞUN BAKIM YÖNETİMİ

Yıl 2015, Cilt: 4 Sayı: 1, 51 - 54, 30.04.2012

Tamer Kuzucuoğlu Serkan Uçkun

Öz

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.

Anahtar Kelimeler

gebelik pnömonisi, sezaryen, solunum yetmezliği

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

Öz

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.

Anahtar Kelimeler

pregnancy pneumonia, caesarean

Kaynakça

• 1. 1.Chen YH, Keller J, Wang IT, Lin CC, Lin HC. Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and Pneumonia and pregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population pregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide populationpregnancy outcomes: a nationwide population-based stud based stud based stud based stud based stud y. Am J y. Am J y. Am J y. Am J y. Am J y. Am J y. Am J Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288 Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288 Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288 Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288 Obstet Gynecol. 2012;207:288Obstet Gynecol. 2012;207:288 -92
• 2. Zhang JP, Wang YH, Chen LN, Zhang R, Xie YE. Clinical analysisi of pregnancy in second and third trimesters cmplicated severe acute respiratory syndrome. Zhonghua Fu Chan Ke Za Zhi. 2003;38:516-20.
• 3. 3-Abduşoğlu M,Erdoğan G,Öztoprak N,Bayar Ü,Turan IÖ,Hancı V. Kifoskolyozlu Bir Gebede Gelişen Pandemik İnfluenza A (H1N1 2009) Pnömonisi.Türk Anest Rean Der Dergisi 2011;39(6):334-340
• 4. 4.Jahromi GS, Zand F, Khosravi A. Acute respiratory distress syndrome associated with H1N1 influenza during pregnancy. Int J Obstet Anesth 2010;19:465-6.
• 5. 5.Tomlinson MW, Caruthers TJ, Whitty JE, Gonik B. Does delivery improve maternal condition in the respiratory-compromised gravida? Obstet Gynecol 1998;91:108-11.
• 6. 6.Jenkins TM, Troiano NH, Graves CR, Baird SM, Boehm FH. Mechanical ventilation in an obstetric population: characteristics and delivery rates. Am J Obstet Gynecol 2003;188:549-52.
• 7. Özlü T. Toplum kökenli tipik pnömoniler. Sendrom 1996; 8(6): 41-6
• 8. Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995;274:639-44.
• 9. Marrie TJ. Community acquired pneumonia. Clin Infect Dis1994;18:501-15.
• 10. 10.Jamiessson DJ ve ark. HINI 2009 Influenza virus infection during pregnancy ın the USA. Lancet 2009; 8: 451-8
• 11. 11.Kosasih H, Bratasena A, Pangesti K, Laras K, Samaan G.Managing seasonal influenza: oseltamivir treatment policy in indonesia? Acta Med Indones.. 2014 ;46(1):58-65.
• 12. 12.Ramsey C, KumarA. HINI: Viral pneumonia as a cause of acute respiratory distres.Curr Opin. Crit Care 2011; 17(1) :64-71
• 13. Ang LT, Gandhi K, Qin YH. Respiratory failure in pregnant women infected by Swine- Origin influenza A (H1N1). Aust N Z J Obstet Gynaecol 2010;50:294-8
• 14. 14 BritoV, Niederman MS. Pneumonia complicating pregnancy. Clin Chest Med. 2011; 32(1):121-32
• 15. Hatipoğlu ON. Pnömonilerde Ayırıcı Tanı. Toraks Dergisi, 2001;2(1):61-68