Case #1
A 32 years old non-Hispanic African American G7P3023 at 24w6d was transferred from an outside hospital (OSH) with acute cholecystitis six days after COVID-19 diagnosis. The patient’s past medical history (PMH) was significant for asthma, pernicious anemia, major depressive disorder, morbid obesity, and obstructive sleep apnea. Upon arrival at our facility patient was receiving supplemental oxygen via nasal cannula (NC). The patient underwent laparoscopic cholecystectomy under general anesthesia and remained intubated. During the next three days, the patient’s condition worsened and required increased ventilatory support. The patient’s family declined Remdesivir or convalescent plasma. Due to deteriorating respiratory condition (increase in PEEP from 12 to 16 and in FiO2 from 50% to 70%, yielding a P/F ratio of 122), the patient was proned for 16 hours (h). This resulted in improved oxygenation (decrease in FiO2 to 50%, yielding a P/F ratio of 305) (Figure 1). After ten hours of a supine position, the patient was proned again for 14h, which further improved oxygenation (PEEP decreased to 14, and FiO2 increased to 430) (Figure 1). The patient was extubated after nine days of mechanical. Fourteen weeks later, the patient presented in spontaneous labor and had an uncomplicated term vaginal delivery and postpartum course.