Acute respiratory failure during pregnancy and the peripartum period
- Peter F Clardy, MD
Peter F Clardy, MD
- Assistant Professor of Medicine
- Harvard Medical School
- Christine C Reardon, MD
Christine C Reardon, MD
- Associate Professor of Medicine
- Boston University School of Medicine
- Section Editors
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
- David L Hepner, MD
David L Hepner, MD
- Section Editor — Obstetric Anesthesia
- Associate Professor of Anaesthesia
- Harvard Medical School
Fewer than 2 percent of women require admission to an intensive care unit (ICU) during pregnancy or the peripartum period, defined as the last month of gestation or the first few weeks following delivery [1-4]. Among those who are admitted to an ICU, the most common indications are postpartum hemorrhage and hypertensive disorders. Acute respiratory failure requiring mechanical ventilation is a rare complication of pregnancy affecting 0.1 to 0.2 percent of pregnancies .
The clinical presentation, differential diagnosis, most common causes, and management of acute respiratory failure during pregnancy and the peripartum period are reviewed here. Other critical illnesses associated with pregnancy are described separately. (See "Critical illness during pregnancy and the peripartum period".)
Patients with acute respiratory failure during pregnancy or the peripartum period generally present with respiratory distress [5-7]. They are typically dyspneic and unable to speak in complete sentences. Confusion, somnolence, agitation, diaphoresis, and/or cyanosis are common.
Most patients are breathing rapidly (tachypnea) and shallowly (small tidal volumes), while using their accessory muscles of respiration. Ausculatory findings vary according to the cause of the acute respiratory failure, but may include crackles, rhonchi, and/or wheezes. Consolidation may be evident, as indicated by bronchophony, egophony, or whisper pectoriloquy.
Initial management is the same regardless of the cause of the acute respiratory failure. Supplemental oxygen should be administered. The preferred method of administering the oxygen depends upon the severity of the hypoxemia. For patients with mild hypoxemia, administration via nasal cannula may be sufficient. More severe hypoxemia generally requires administration via a facemask, high flow nasal cannula, or a nonrebreather mask. Oxygenation should be monitored continuously by pulse oximetry. A reasonable goal for pregnant patients is to maintain the oxyhemoglobin saturation ≥95 percent to optimize the fetal oxygen content. Adequate fetal oxygenation requires a maternal arterial oxygen tension (PaO2) >70 mmHg, which corresponds to an oxyhemoglobin saturation of 95 percent .
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- CLINICAL PRESENTATION
- INITIAL MANAGEMENT
- DIFFERENTIAL DIAGNOSIS
- Pulmonary edema
- - Tocolytics
- - Cardiogenic
- - Preeclampsia or eclampsia
- Asthma exacerbation
- - Management
- Pulmonary embolism
- Amniotic fluid embolism
- Air embolism
- Acute respiratory distress syndrome
- ONGOING MANAGEMENT
- Directed therapy
- Supportive care
- SUMMARY AND RECOMMENDATIONS