Prone position improved arterial oxygenation in a patient with HELLP syndrome

Abstract

A 25-year-old primigravid (25 weeks) was delivered by cesarean section because of abruptio placenta and fetal death. She was admitted to our ICU because of her respiratory insufficiency. Preeclampsia history, elevated liver function tests, low platelets and anemia suggested HELLP syndrome. A progressive dyspnea developed on the third day and the patient was intubated. Although she was ventilated with a FiO2 of 0.8 and a PEEP of 10cm H2O, arterial hypoxemia persisted. Therefore, we considered ventilating her in prone position. In prone position, PaO2 and postural drainage increased significantly compared to supine position. During this period, platelets increased virtually while liver function tests were decreasing to normal levels. She was turned to supine position after 48 hours. The patient was discharged without sequale 24 days after her admission to ICU. Our indication for the use of prone position in this case was; inadequate oxygenation despite high FiO2 and PEEP levels. We achieved optimum PaO2 with the least FiO2 and better secretion removal in prone position.