15-Safety of Remdesivir and Inhaled Nitric Oxide in a Pregnant Patient With Twins: A Case Report
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Obstetrics, Crisis Management, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Rajkamal Hansra, MD

Introduction: Limited data is available for management of COVID-19 in pregnant patients and teratogenicity of remdesivir. We present a case of a mother with twin gestation admitted to the intensive care unit with severe COVID19 pneumonia and acute respiratory distress syndrome who was treated with mechanical ventilation, remdesivir and inhaled nitric oxide (iNO).

Description: A 26 year old female with history of mild intermittent asthma and morbid obesity at 29 weeks gestations with dichorionic diamniotic twins who presented with hypoxemia and laboratory confirmed SARS-CoV-2 positive. She failed to maintain goal oxygen saturations despite maximal support with high flow nasal cannula and required intubation and mechanical ventilation. A high PEEP low tidal volume strategy was utilized as well as initiation of iNO to obtain saturation goals of greater than 95% which is the minimal set threshold in pregnancy. The patient received remdesivir, iNO, and steroids on day 1 of ICU admission. On ICU day 6 she developed pre-eclampsia with severe features and she was taken to the operating room for successful delivery via cesarean section at 30 weeks gestation. Following delivery she demonstrated rapid improvement in clinical status and on day 10 was successfully extubated. Twin A was a male fetus born with APGAR scores of 6 and 8 at 1 and 5 minutes respectively. Twin B was a female fetus born with APGAR scores of 7 and 8 at 1 and 5 minutes. Both infants required endotracheal intubation for respiratory distress and tested negative for SARS-CoV-2. They demonstrated chest imaging consistent with surfactant deficiency and received exogenous surfactant. They were diagnosed with bronchopulmonary dysplasia but were able to be extubated and weaned to 0.2L nasal cannula.

Discussion: This case suggests successful use of remdesivir and iNO in addition to low tidal volume ventilation strategy mechanical ventilation in a pregnant patient with twin gestation. Both infants underwent an expected neonatal ICU course for premature delivery at 30 weeks and to our knowledge no complications were attributed to remdesivir or iNO. While more research in the form of randomized clinical trials is needed to demonstrate safety and efficacy of these therapeutic modalities clinicians may consider taking a similar approach.


Meta Tag
Content Type Presentation
Knowledge Area Obstetrics
Knowledge Area Crisis Management
Knowledge Level Advanced
Membership Level Select
Tag COVID-19
Tag Pregnancy
Year 2021
pregnant mother
COVID pneumonia
acute respiratory distress syndrome
inhaled nitric oxide


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