Gagal Napas Akut dengan Hipoksemia Refrakter pada Preeklampsi Berat Aplikasi “PEEP Tinggi dan Balans Cairan Negatif” di ICU


Faisal Sommeng


Introduction: Acute pulmonary edema in pregnancy due to preeclampsia is a life-threatening event and  a form of maternal morbidity. The hypoxemia is clinical manifestation feature. Refractory hypoxemia is an increasing in the partial pressure of oxygen in the arteries (PaO2) <5 mmHg with a 10% increase in FiO2 or PaO2 <60 mmHg or P/F ratio <100 on FiO2 80-100% with PEEP> 10-20 cmH20 at more than 12- 24 hours. In this case, a 35-year-old female patient entered to the ICU Wahidin Sudirohusodo General Hospital from the emergency room operating teater  with acute pulmonary edema ec PEB + Post Sectio cesarian, mechanical ventilation (VM) PCV+ Pins 20 mode, PEEP 10, PS 15, RR 20, Vt 350 – 400 ml, FiO2 100% was performed and maximum SpO2 produced only up to 96%, P/F ratio 95,2. After 11 hours of mechanical ventilation, blood gas analysis obtained pH 7.52, PaCO2 28.5, sat 89.6%, PaO2 50.1 HCO3 23.2 BE 2.2 P/F ratio 62 with 100% FiO2 and airway pressure 30 cmH2O and was diagnose refractory hypoxemic.

Therapy: Sedation, administration of muscle relaxants, changes in high PEEP ventilator settings and fluid evacuation. setting high PEEP up to 25 cmH2O by increasing the A / W pressure every 2 minutes periodically until 55 cmH2O hold for 2 minutes and setting ventilator PCV: Pinsp 20, PEEP 15-20, FiO2 80%. and fluid evacuation with diuretics is carried out.

Results: Improvement of P / F ratio up to 139 at the time of recruitment maneuver and P / F ratio improved up to 244 after 6 hours of the maneuver. the patient was weaning from the ventilator at 5th day care with P / F ratio 313 and tranfer to ward care on the 6th day care.