Nitric oxide in the treatment of fulminant pulmonary failure in a young pregnant woman with varicella pneumonia

Extracorporeal membrane oxygenation is the recommended treatment for fulmin ant pulmonary failure due to varicella pneumonia. However, in pregnancy fet al viability during extracorporeal membrane oxygenation is generally poor r esulting in either therapeutic or spontaneous abortion. The present case is to our knowledge the first report on the treatment with nitric oxide to im prove oxygenation in a pregnant woman with fulminant pulmonary failure due to varicella pneumonia. Adding 20 parts per million nitric oxide to the ins piratory gas increased arterial oxygen saturation from 75 to 88%, and it co uld be kept at this level. Due to a vaginal bleeding, an emergency Caesarea n section was performed with successful outcome for the fetus. The mother s tarted to improve after delivery and could be weaned from nitric oxide afte r 5 days. We conclude that inhalation of nitric oxide may be a good alterna tive to extracorporeal membrane oxygenation in the treatment of fulminant p ulmonary failure due to varicella pneumonia in pregnancy.