Acute respiratory failure following ovarian hyperstimulation syndrome

  • Antonello Nicolini | antonello.nicolini@fastwebnet.it SSD Pneumologia Ospedale di Sestri Levante (GE), Italy.
  • Alessandro Perazzo SSD Pneumologia Ospedale di Sestri Levante (GE), Italy.
  • Piergiorgio Gatto SSD Pneumologia Ospedale di Sestri Levante (GE), Italy.
  • Mario Santo SC Medicina d’Urgenza Ospedale di Lavagna (GE), Italy.
  • Monica Bonfiglio SSD Rianimazione Ospedale di Lavagna (GE), Italy.

Abstract

Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6) ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non-invasive ventilation.

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Author Biography

Antonello Nicolini, SSD Pneumologia Ospedale di Sestri Levante (GE)
Published
2013-03-04
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Issue
Section
Case Reports
Keywords:
ovarian hyperstimulation syndrome, massive pleural effusion, severe respiratory failure, non-invasive ventilation.
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How to Cite
Nicolini, A., Perazzo, A., Gatto, P., Santo, M., & Bonfiglio, M. (2013). Acute respiratory failure following ovarian hyperstimulation syndrome. Italian Journal of Medicine, 7(1), 43-47. https://doi.org/10.4081/itjm.2013.43