Furosemide
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No effect: case report A 41-year-old woman’s furosemide treatment showed no effect for acute respiratory distress syndrome (ARDS) during pregnancy. The woman, with G5P4 and 32 weeks of pregnancy, presented to the emergency department with 3 day history of dry cough, shortness of breath and headache. She had been receiving regular prenatal care. At that time, her BMI was 35.6. At the time of admission, she had normal BP with heart rate of 99 bpm and respiratory rate of 24 bpm. Subsequent chest X-ray showed diffuse bilateral alveolar infiltrates. Following a diagnosis of sepsis from community acquired pneumonia, she was admitted to a general medical floor. She started receiving empiric antibiotic therapy with ceftriaxone and azithromycin. After a few hours, her COVID-19 PCR swab test, which was done at the time of her admission, returned positive. During her hospitalisation, her oxygenation steadily worsened. Approximately after 15 hours of admission, oxygen saturation dropped below 90%. Therefore, she started receiving supplemental oxygen 3 L/min. Approximately after 24 hours of admission, oxygen via high flow nasal cannula (HFNC) was started. An arterial-blood gas (ABG) revealed a PaO2 of 111mm Hg (PaO2:FiO2 ratio of 111, indicative of moderate ARDS. Therefore, she was transferred to the ICU. After 7 hours, a repeat ABG showed progressively worsening oxygenation. She received single dose of IV furosemide 40mg; however, she had no effect. She started receiving IV dexamethasone. Subsequently, she was then intubated. An ultrasound revealed placenta previa with possible accreta. Her pregnancy was considered to be contributing to her condition. The fetus was not exhibiting any signs of distress. As she had no vaginal bleeding, an urgent delivery was not indicated. After 35 hours of admission, endotracheal intubation was performed in the operating room, along with a setup for possible caesarian section. She had an uneventful intubation. For intubation, she received sevoflurane, rocuronium-bromide [rocuronium] and suxamethoniumchloride [succinylcholine]. However, immediately post intubation, her respiratory status became unstable. The ventilator settings were rapidly increased. She was then transferred back to the ICU. She started receiving fentanyl for sedation and intermittent midazolam infusions for breakthrough pain and agitation. After 2 hours of intubation, a repeat ABG revealed improved oxygenation. Ventilator settings were adjusted. After 38 hours of admission, she exhibited vaginal bleeding. She underwent emergent cesarean section. She received sevoflurane, rocuronium, midazolam, fentanyl, oxytocin, phenylephrine and IV bicarbonate for caesarean section. She delivered a male neonate with Apgar score of 0, 5, and 7. Neonate was observed to be limp with no spontaneous breathing. Therefore, the neonate was intubated. The neonate had a decrease in heart rate to 60, for which brief compressions were performed. Subsequently, she (the mother) was transferred back to the ICU. Over the next 24 hours, her oxygenation
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