No Added Risk During Ventilation for Pregnant Patients

A new study shows that maternal mortality in obstetric patients, as related to mechanical ventilation, has the same associated factors as in the non-obstetric population.

Researchers at the University of Cartagena (Colombia), Brown University (Providence, RI, USA), and other institutions conducted a retrospective observational study that included 2,116 obstetric patients (median age 26) in six hospitals in Colombia to identify risk factors of maternal mortality in mechanically ventilated patients. The study cohort included patients admitted to the intensive care unit (ICU), and who required mechanical ventilation for more than 24 hours. Discrimination analysis was conducted continuously on clinical and laboratory variables for their ability to predict mortality.

The results revealed that 299 (14%) of the pregnant women within the study suffered acute respiratory failure and required mechanical ventilation. Obstetric hemorrhage, hypertensive disorders of pregnancy, and maternal sepsis were the most common indications for mechanical ventilation. Factors identified as related to higher mortality included use of a vasopressor, blood transfusions, neurological dysfunction, coagulopathy, and acute respiratory distress syndrome (ARDS). The study was presented at the CHEST annual meeting, held during October 2018, in San Antonio (TX, USA).

“The results show that ARDS, the presence of coagulopathy, and neurological dysfunction are clinical factors associated with mortality,” said study presenter and co-author Jose Antonio Rojas-Suarez, MD, MSc, of the University of Cartagena. “Nulliparity was associated with a lower risk of death. Clinical variables that showed an acceptable discrimination capacity as predictors of mortality were mean blood pressure and pH.”

Causes of ARDS related to pregnancy include epidural blocks, amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception that can include aspiration pneumonitis, influenza pneumonia, blood transfusions, sepsis, and trauma. ARDS in pregnancy also poses its own set of unique challenges, as two circulatory systems are being ventilated using only one set of diseased lungs. Despite extensive research to improve the management of ARDS, mortality remains high, and few strategies have shown a mortality benefit.

Related Links:
University of Cartagena
Brown University