Lung Protective Ventilation during Pregnancy: An Observational Cohort Study

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 > 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 predicted body weight, and HTVV as >8ml/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). Conclusions: 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.