Prone position in pregnant woman with major burns with severe ARDS on mechanical ventilation

Abstract

Burns are skin lesions determined by the thermal energy of heat transfer with cellular protein denaturation. Although infrequent during pregnancy, they can be fatal for both the mother and fetus. The outcome depends on factors related to the burns themselves, such as depth and percentage of body surface burned. Burns that affect more than 20% of the body surface can cause systemic inflammatory response syndrome (SIRS) and acute respiratory distress syndrome (ARDS) with high rates of fetal death and asphyxia. In ARDS, the prone position has been used for over 40 years to promote homogenization of stress distribution and pulmonary strain with improved ventilation/perfusion. However, pregnancy and major burns may constitute relative contraindications related to the prone position due to abdominal and pelvic compression, difficulty in monitoring fetal heartbeats and complications in face and belly burns. The set of contraindications associated with the need for the prone position guided the objective of this case report, which aimed to describe and review the literature to discuss the clinical case, as well as demonstrate the favorable results of gas exchange and ventilatory mechanics in relation to the prone position in pregnant woman with major burns without complications.