Anestéziológia a intenzívna medicína 1/2013

Infection by influenza A/H1N1 in a pregnant woman – a case report

One of the most abhorred and yet not conclusively rare complication of influenza caused by A/H1N1 virus infection is supposed to be the global respiratory insufficiency with the development of ALI/ARDS, only marginally responsive to our therapeutic interventions.Pregnancy has become a significant risk factor of this infection, especially due to particular changes within the physiology of the immune system. In the context of therapeutic procedures available, the actual supplementation of the exogenous surfactant seems to be one of the possible effective alternatives. A 22 years old female subject at the 30th week of pregnancy was hospitalized at KAIM FNsP NZ with the confirmed infection of A/H1N1, severe global respiratory insufficiency, respiratory index of 82 mmHg and ARDS development verified on CT scans. Despite the onset therapy the actual refractory hypoxemia persists within the subject´s clinical picture, therefore we proceed to terminate the pregnancy prematurely through the cesarean section and notwithstanding the off-label indication, we administer the surfactant. After repeated doses administration, the significant improvement of respiratory and ventilation parameters was expressed and the regression of lung parenchyma condensation and ARDS signs within CT scans could be observed.

Keywords: ALI/ARDS, H1N1, exogenous surfactant, respiratory failure.