巴黎地区三级妇产医院对因 SARS-CoV-2 导致的急性低氧血症呼吸衰竭而转入重症监护室的孕妇的管理:哪些做法会产生哪些结果?

IF 5.7 1区 医学 Q1 CRITICAL CARE MEDICINE Annals of Intensive Care Pub Date : 2024-06-18 DOI:10.1186/s13613-024-01313-2
Frédérique Schortgen, Cecilia Tabra Osorio, Suela Demiri, Cléo Dzogang, Camille Jung, Audrey Lavenu, Edouard Lecarpentier
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引用次数: 0

摘要

背景:目前尚缺乏治疗急性低氧血症呼吸衰竭(AHRF)孕妇的证据。避免插管的可能性以及在有创通气下继续妊娠的风险仍未确定。我们报告了巴黎地区三级妇产医院重症监护室收治的 SARS-CoV-2 肺炎孕妇的治疗情况和结果:我们对 15 家重症监护室收治的因 SARS-CoV-2 导致 AHRF 的孕妇进行了回顾性队列研究,其定义为需要氧气≥ 6 L/min、高流量鼻氧(HFNO)、无创或有创通气。对轨迹进行评估,以确定是否需要插管以及是否有可能在有创通气的情况下继续妊娠:共纳入 177 名孕妇,年龄 34(IQR:30-38)岁,孕周 27(IQR:25-30)周。37/107的孕妇患有肥胖症。47/107(44%)例患者需要插管。根据呼吸支持的不同,标准氧气插管率为 14/19 (74%),无创通气为 17/36 (47%),HFNO 为 16/52 (31%)。与插管明显相关的因素有肺部合并感染:调整后 OR:3.38(95% CI 1.31-9.21),HFNO:0.11(0.02-0.41),无创通气:0.20(0.04-0.41):0.20 (0.04-0.80).46名产妇(43%)在重症监护室住院期间分娩,其中39/46(85%)因产妇肺部恶化而分娩,41/46(89%)在早产阶段分娩。14名未插管的产妇在区域麻醉下分娩;9/14最终需要紧急插管。发现了四种不同的轨迹:19 名产妇在进入重症监护室后 2 天内分娩,但未插管(12 名产妇需要长时间插管);23 名产妇在插管后 2 天内分娩;11 名插管产妇继续妊娠,8/11 名产妇在重症监护室出院后分娩;54 名产妇从未插管(53 名产妇在出院后分娩)。插管后的分娩时间主要取决于胎龄。有 1 例产妇死亡和 1 例胎儿死亡的记录:结论:在患有与 SARS-CoV-2 相关的 AHRF 的孕妇中,HFNO 和无创机械通气与插管率降低有关,而肺部合并感染与插管率升高有关。三分之一的插管妇女在有创机械通气后继续妊娠。研究注册回顾性登记在 ClinicalTrials (NCT05193526) 上。
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Management of pregnant women in tertiary maternity hospitals in the Paris area referred to the intensive care unit for acute hypoxaemic respiratory failure related to SARS-CoV-2: which practices for which outcomes?

Background: Evidence for the management of pregnant women with acute hypoxaemic respiratory failure (AHRF) is currently lacking. The likelihood of avoiding intubation and the risks of continuing the pregnancy under invasive ventilation remain undetermined. We report the management and outcome of pregnant women with pneumonia related to SARS-CoV-2 admitted to the ICU of tertiary maternity hospitals of the Paris area.

Methods: We studied a retrospective cohort of pregnant women admitted to 15 ICUs with AHRF related to SARS-CoV-2 defined by the need for O2 ≥ 6 L/min, high-flow nasal oxygen (HFNO), non-invasive or invasive ventilation. Trajectories were assessed to determine the need for intubation and the possibility of continuing the pregnancy on invasive ventilation.

Results: One hundred and seven pregnant women, 34 (IQR: 30-38) years old, at a gestational age of 27 (IQR: 25-30) weeks were included. Obesity was present in 37/107. Intubation was required in 47/107 (44%). Intubation rate according to respiratory support was 14/19 (74%) for standard O2, 17/36 (47%) for non-invasive ventilation and 16/52 (31%) for HFNO. Factors significantly associated with intubation were pulmonary co-infection: adjusted OR: 3.38 (95% CI 1.31-9.21), HFNO: 0.11 (0.02-0.41) and non-invasive ventilation: 0.20 (0.04-0.80). Forty-six (43%) women were delivered during ICU stay, 39/46 (85%) for maternal pulmonary worsening, 41/46 (89%) at a preterm stage. Fourteen non-intubated women were delivered under regional anaesthesia; 9/14 ultimately required emergency intubation. Four different trajectories were identified: 19 women were delivered within 2 days after ICU admission while not intubated (12 required prolonged intubation), 23 women were delivered within 2 days after intubation, in 11 intubated women pregnancy was continued allowing delivery after ICU discharge in 8/11, 54 women were never intubated (53 were delivered after discharge). Timing of delivery after intubation was mainly dictated by gestational age. One maternal death and one foetal death were recorded.

Conclusion: In pregnant women with AHRF related to SARS-CoV-2, HFNO and non-invasive mechanical ventilation were associated with a reduced rate of intubation, while pulmonary co-infection was associated with an increased rate. Pregnancy was continued on invasive mechanical ventilation in one-third of intubated women. Study registration retrospectively registered in ClinicalTrials (NCT05193526).

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来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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