Point-of-care ultrasound-guided fluid management in acute respiratory failure complicating preeclampsia and thyrotoxicosis: a case report.

The coexistence of preeclampsia and uncontrolled thyrotoxicosis leading to acute respiratory failure is rare and poses significant diagnostic and therapeutic challenges, particularly with respect to safe fluid management in the obstetric intensive care setting. We report the case of a 35-year-old woman at 37-week gestation who presented with progressive dyspnea, acute pulmonary edema, and fetal distress, necessitating emergency cesarean section and subsequent intensive care admission. Point-of-care ultrasound (POCUS) demonstrated impaired left ventricular systolic function (ejection fraction 40%), reduced left ventricular outflow tract velocity time integral (LVOT VTI 10-11 cm), a dilated inferior vena cava, and diffuse pulmonary B-lines, consistent with volume overload and compromised forward cardiac output. Serial POCUS-guided assessments were used to titrate diuretic therapy and optimize mechanical ventilation, resulting in progressive improvement in LVOT VTI (up to 20 cm), resolution of pulmonary edema, achievement of negative fluid balance, and clinical recovery. The patient was successfully extubated on day 5 and discharged home on day 7. This case demonstrates the clinical utility of POCUS, particularly serial LVOT VTI measurements, in providing actionable, dynamic bedside data to safely guide fluid management when static hemodynamic indices are unreliable, highlighting the value of POCUS in complex high-risk obstetric critical care.