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. 2021 Dec;25(Suppl 3):S241-S247.
doi: 10.5005/jp-journals-10071-24036.

Acute Respiratory Distress Syndrome in Pregnancy

Sunil T Pandya  1 , Sai J Krishna  1
Affiliations

Acute Respiratory Distress Syndrome in Pregnancy

Sunil T Pandya et al. Indian J Crit Care Med. 2021 Dec.

Abstract

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by several clinical features and pathological responses involving the respiratory system primarily. Infections (viral), sepsis, and massive transfusion are the commonest causes of ARDS during pregnancy. The majority of them recover with noninvasive ventilatory (NIV) support. NIV is safe in pregnancy provided the center is experienced and has a protocolized patient care pathway. Parturients requiring invasive mechanical ventilation are best managed in experienced centers. PaO2/FiO2 targets are higher in parturients compared to nonpregnant patients. Permissive hypercapnia is not a safe option in pregnancy. In severe ARDS with refractory hypoxemia, prone ventilation is a safe option. However, it has to be done in experienced centers. Venovenous ECMO is a safe alternative option in pregnant women with refractory hypoxemia, and delivery has been prolonged to a safe viable age on ECMO. The decision to deliver and the mode of delivery have to be a multidisciplinary decision; primary criterion is maternal survival. Postdelivery, establishing maternal bonding while in ventilatory support facilitates early weaning and minimizes lactation failure.

How to cite this article: Pandya ST, Krishna SJ. Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med 2021; 25(Suppl 3):S241-S247.

Keywords: ARDS; ECMO; NIV; Pregnancy; Prone; Ventilation.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Common causes of pregnant women requiring high-dependency unit and ICU admissions, Clinical audit data, 2015, Fernandez Hospital, Hyderabad, India
Fig. 2
Fig. 2
Lung is the most common organ involved in sick parturients requiring ICU admissions, Clinical audit data, Fernandez Hospital, Hyderabad, India
Fig. 3
Fig. 3
Placental gas exchange
Figs 4A and B
Figs 4A and B
(A) Oxygen dissociation curves for mother and fetus; (B) Maternofetal gas values
Fig. 5
Fig. 5
NIV in a term parturient with maternal and fetal monitoring
Figs 6A and B
Figs 6A and B
(A) Bedside chest X-ray showing severe features of ARDS bilaterally due to H1N1 pneumonia; (B) CT scan of the chest showing severe ground glass opacities bilaterally with refractory hypoxemia, COVID-19 pneumonia
Figs 7A and B
Figs 7A and B
Prone ventilation in a parturient with free abdominal wall to minimize aortocaval compression
Fig. 8
Fig. 8
Patient on VV-ECMO support
Figs 9A to C
Figs 9A to C
(A) Early maternal and family bonding; (B) Early breastfeeding while on mechanical ventilatory support; (C) Early rehabilitation, ambulation while on ventilatory support
See this image and copyright information in PMC

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