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Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome
  1. Meenupriya Arasu,
  2. Nagalakshmi Swaminathan,
  3. Anusha Cherian and
  4. Magesh Parthiban
  1. Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India
  1. Correspondence to Dr Anusha Cherian; anushacherian{at}


A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk–benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.

  • adult intensive care
  • pregnancy
  • ultrasonography
  • infectious diseases
  • mechanical ventilation

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  • Contributors MA, NS, AC and MP actively involved in the management of this patient in the critical care and step down unit. MA, NS, AC and MP contributed substantially towards data acquisition, analysis and interpretation as well as literature review. Drafting the manuscript and revising it critically for important intellectual content approval was done by MA, NS and AC. Final manuscript draft was approved by all authors MA, NS, AC, MP. AC agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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