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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e111-e119
DOI: 10.1055/a-2207-9917
Original Article

Lung Protective Ventilation during Pregnancy: An Observational Cohort Study

Yasaswi Kislovskiy 
1   Department of Obstetrics and Gynecology, Women's Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
,
Alisse Hauspurg
2   Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Women's Hospital, Pittsburgh, Pennsylvania
3   Magee-Womens Research Institute, Pittsburgh, Pennsylvania
,
Chenell Donadee
4   Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Sara Sakamoto
2   Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC Magee-Women's Hospital, Pittsburgh, Pennsylvania
3   Magee-Womens Research Institute, Pittsburgh, Pennsylvania
,
Raghavan Murugan
4   Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
› Author Affiliations Funding Y.K. has received consulting fees from Gilead Sciences. This work was supported by U.S. Department of Health and Human Services, National Institutes of Health/Office of Research on Women's Health Building Interdisciplinary Research Careers in Women's Health (BIRCWH) NIH K12HD043441 scholar funds to A.H.
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Abstract

Objectives We sought to describe characteristics of mechanically ventilated pregnant patients, evaluate utilization of low-tidal-volume ventilation (LTVV) and high-tidal-volume ventilation (HTVV) by trimester, and describe maternal and fetal outcomes by ventilation strategy.

Study Design This is a retrospective cohort study of pregnant women with mechanical ventilation for greater than 24 hours between July 2012 and August 2020 at a tertiary care academic medical center. We defined LTVV as average daily tidal volume 8 mL/kg of less of predicted body weight, and HTVV as greater than 8 mL/kg. We examined demographic characteristics, maternal and fetal characteristics, and outcomes by ventilation strategy.

Results We identified 52 ventilated pregnant women, 43 had LTVV, and 9 had HTVV. Acute respiratory distress syndrome occurred in 73% (N = 38) of patients, and infection was a common indication for ventilation (N = 33, 63%). Patients had LTVV more often than HTVV in all trimesters. Obstetric complications occurred frequently, 21% (N = 11) experienced preeclampsia or eclampsia, and among 43 patients with available delivery data, 60% delivered preterm (N = 26) and 16% had fetal demise (N = 7).

Conclusion LTVV was utilized more often than HTVV among pregnant women in all trimesters. There was a high prevalence of maternal and fetal morbidity and fetal mortality among our cohort.

Key Points

  • Our center utilized low tidal more often than high-tidal-volume ventilation during all trimesters of pregnancy.

  • Prone positioning can be performed at advanced gestations.

  • Infection is a common cause of antepartum ventilation.

Keywords

mechanical ventilation - obstetric - low-tidal-volume ventilation - respiratory illness - pregnancy


Publication History

Received: 25 March 2021

Accepted: 20 October 2023

Accepted Manuscript online:
09 November 2023

Article published online:
16 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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