Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature

Abstract

Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.

Rapid Progression of Lung Cancer Following Emergency Caesarean Section Led to Postpartum Acute Respiratory Failure

“…Pulmonary thromboembolism is complicated in 0.05%-0.3% of pregnancies and is the leading nonobstetric cause of acute respiratory failure in pregnant patients (2). The incidence of malignant tumors in pregnant women was reported to be 1 in 1,000 pregnant women; although a relatively high incidence of breast cancer, cervical cancer, malignant lymphoma, malignant melanoma, and leukemia is reported in pregnant women, the occurrence of lung cancer is extremely rare (3).…”

“…Acute respiratory failure after delivery has a broad differential diagnosis. Venous thromboembolism, cardiovascular disease, pulmonary hypertension, bronchial asthma, respiratory infection, neuromuscular disorders, and sepsis are recognized as non-obstetric causes of acute respiratory failure during pregnancy and puerperium (2), although lung cancer is a rare cause (3). In addition, rapid progression of lung cancer after delivery is uncommon.…”

Severe and critical COVID-19 in pregnancy: A case series from Montreal

“… 11 While intrinsic lung compliance is unaltered, chest wall and total compliance decrease by approximately 30% in pregnancy. 11 – 13 The risk of respiratory failure is further increased by the decrease in functional residual capacity (FRC). Mechanical ventilation in pregnant women poses many challenges, including the increased risk of intubation failure due to increased airway edema, decreased FRC, and higher risk of aspiration.…”

The Management of Pregnant Trauma Patients: A Narrative Review

“…Therefore, mechanical ventilation should target a Paco 2 level that is normal for pregnancy (27-32 mm Hg). 15,45 Paco 2 levels nearing normal adult levels of 35 to 40 mm Hg should raise concern for potential hypercarbic respiratory failure in a spontaneously breathing pregnant trauma patient.…”