Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 25 , ISSUE S3 ( December, 2021 ) > List of Articles

INVITED ARTICLE

Acute Respiratory Distress Syndrome in Pregnancy

Sunil T Pandya, Sai J Krishna

Keywords : ARDS, ECMO, NIV, Pregnancy, Prone, Ventilation

Citation Information :

DOI: 10.5005/jp-journals-10071-24036

License: CC BY-NC 4.0

Published Online: 12-01-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by several clinical features and pathological responses involving the respiratory system primarily. Infections (viral), sepsis, and massive transfusion are the commonest causes of ARDS during pregnancy. The majority of them recover with noninvasive ventilatory (NIV) support. NIV is safe in pregnancy provided the center is experienced and has a protocolized patient care pathway. Parturients requiring invasive mechanical ventilation are best managed in experienced centers. PaO2/FiO2 targets are higher in parturients compared to nonpregnant patients. Permissive hypercapnia is not a safe option in pregnancy. In severe ARDS with refractory hypoxemia, prone ventilation is a safe option. However, it has to be done in experienced centers. Venovenous ECMO is a safe alternative option in pregnant women with refractory hypoxemia, and delivery has been prolonged to a safe viable age on ECMO. The decision to deliver and the mode of delivery have to be a multidisciplinary decision; primary criterion is maternal survival. Postdelivery, establishing maternal bonding while in ventilatory support facilitates early weaning and minimizes lactation failure.

PDF Share
  1. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA 2012;307(23):2526–2533. DOI: 10.1001/jama.2012.5669.
  2. Papazian L, Aubron C, Brochard L, Chiche JD, Combes A, Dreyfuss D, et al. Formal guidelines: management of acute respiratory distress syndrome. Ann Intensive Care 2019;9(1):69. DOI: 10.1186/s13613-019-0540-9. PMID: 31197492; PMCID: PMC6565761.
  3. Riviello ED, Buregeya E, Twagirumugabe T. Diagnosing acute respiratory distress syndrome in resource limited settings: the Kigali modification of the Berlin definition. Curr Opin Crit Care 2017;23(1): 18–23. DOI: 10.1097/MCC.0000000000000372. PMID: 27875408.
  4. Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: a narrative review of literature. J Anaesthesiol Clin Pharmacol 2016;32(4):431–439. DOI: 10.4103/0970-9185.194779. PMID: 28096571; PMCID: PMC5187605.
  5. Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med 2011;32(1):1–13. DOI: 10.1016/j.ccm.2010.11.001.
  6. Bobrowski RA. Pulmonary physiology in pregnancy. Clin Obstet Gynecol 2010;53(2):285–300. DOI: 10.1097/GRF.0b013e3181e04776.
  7. Crapo RO. Normal cardiopulmonary physiology during pregnancy. Clin Obstet Gynecol 1996;39(1):3–16. DOI: 10.1097/00003081-199603000-00004.
  8. Templeton A, Kelman GR. Maternal blood-gases (PaO2-PaO2), hysiological shunt and VD/VT in normal pregnancy. Br J Anaesth 1976;48(10):1001–1004. DOI: 10.1093/bja/48.10.1001.
  9. Catanzarite V, Williams D, Wong D, Landers C, Cousins L, Schrimmer D. Acute respiratory distress syndrome in pregnancy and the puerperium: Causes, courses, and outcomes. Obstet Gynecol 2001;97(5 Pt1):760–764. DOI: 10.1016/s0029-7844(00)01231-x.
  10. Al-Ansari MA, Hameed AA, Al-jawder SE, Saeed HM. Use of noninvasive positive pressure ventilation during pregnancy: case series. Ann Thorac Med 2007;2(1):23–25. DOI: 10.4103/1817-1737.30358.
  11. Mabie WC, Barton JR, Sibai BM. Adult respiratory distress syndrome in pregnancy. Am J Obstet Gynecol 1992;167(4 Pt 1):950–957. DOI: 10.1016/s0002-9378(12)80018-4.
  12. Smith JL, Thomas F, Orme JF Jr, Clemmer TP. Adult respiratory distress syndrome during pregnancy and immediately postpartum. West J Med 1990;153(5):508–510. PMID: 2260285; PMCID: PMC1002600.
  13. Perry KG Jr, Martin RW, Blake PG, Roberts WE, Martin JN Jr. Maternal mortality associated with adult respiratory distress syndrome. South Med J 1998;91(5):441–444. DOI: 10.1097/00007611-199805000-00006.
  14. Wanderer JP, Leffert LR, Mhyre JM, Kuklina EV, Callaghan WM, Bateman BT. Epidemiology of obstetric-related ICU admissions in Maryland: 1999-2008. Crit Care Med 2013;41(8):1844–1852. DOI: 10.1097/CCM.0b013e31828a3e24.
  15. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000;342(18):1301–1308. DOI: 10.1056/NEJM200005043421801.
  16. Peck TJ, Hibbert KA. Recent advances in the understanding and management of ARDS. F1000Res 2019;8:F1000 Faculty Rev-1959. DOI: 10.12688/f1000research.20411.1. PMID: 31824644; PMCID: PMC6880255.
  17. Kacmarek RM, Villar J, Sulemanji D, Montiel R, Ferrando C, Blanco J, et al. Open lung approach for the acute respiratory distress syndrome: a pilot, randomized controlled trial. Crit Care Med 2016;44(1):32–42. DOI: 10.1097/CCM.0000000000001383.
  18. Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, et al. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004;351(4):327–336. DOI: 10.1056/NEJMoa032193.
  19. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa ELV, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372(8):747–755. DOI: 10.1056/NEJMsa1410639.
  20. Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, de Moraes Paisani D, Damiani LP, et al. Effect of lung recruitment and titrated positive end-expiratory pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2017;318(14):1335–1345. DOI: 10.1001/jama.2017.14171.
  21. Beitler JR, Sarge T, Banner-Goodspeed VM, Gong MN, Cook D, Novack V, et al. Effect of titrating positive end-expiratory pressure (PEEP) with an esophageal pressure-guided strategy vs an empirical high PEEP-FiO2 strategy on death and days free from mechanical ventilation among patients with acute respiratory distress syndrome: a randomized clinical trial. JAMA 2019;321(9):846–857. DOI: 10.1001/jama.2019.0555.
  22. Campbell LA, Klocke RA. Implications for the pregnant patient. Am J Respir Crit Care Med 2001;163(5):1051–1054. DOI: 10.1164/ajrccm.163.5.16353.
  23. Banga A, Khilnani GC. Use of non-invasive ventilation in a pregnant woman with acute respiratory distress syndrome due to pneumonia. Indian J Chest Dis Allied Sci 2009;51(2):115–117. PMID: 19445449.
  24. Nair P, Davies AR, Beca J, Bellomo R, Ellwood D, Forrest P, et al. Extracorporeal membrane oxygenation for severe ARDS in pregnant and postpartum women during the 2009 H1N1 pandemic. Intensive Care Med 2011;37(4):648–654. DOI: 10.1007/s00134-011-2138-z.
  25. Moore SA, Dietl CA, Coleman DM. Extracorporeal life support during pregnancy. J Thorac Cardiovasc Surg 2016;151(4):1154–1160. DOI: 10.1016/j.jtcvs.2015.12.027. PMID: 26825433.
  26. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368(23):2159–2168. DOI: 10.1056/NEJMoa1214103.
  27. Samanta S, Samanta S, Wig J, Baronia AK. How safe is the prone position in acute respiratory distress syndrome at late pregnancy? Am J Emerg Med 2014;32(6):687.e1–687.e3. DOI: 10.1016/j.ajem.2013.12.021. PMID: 24412021.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.