Mechanical Ventilation and ARDS in Critical Care Obstetrics
Download MP3Mechanical Ventilation and ARDS – Podcast Summary and References
This is the sixth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams as a retrieval OBGYN/MFM and is one of our Assistant Medical Directors for the flight program.
The topic of this podcast is Mechanical Ventilation and ARDS in pregnancy. Although respiratory distress requiring intubation and ARDS in pregnancy is not very common, it is more common than some of the other pathologies we have discussed recently. Mechanical ventilation of the pregnant patient can be intimidating, but rest assured that if you have the capabilities to manage other patients on a vent, you can manage the pregnant patient. Generally speaking solid outcomes data is sparse and, generally speaking, most guidelines recommend vent management of mechanical ventilation in patients with or without ARDS similarly to non-pregnant patients…with a few exceptions. This podcast reviews the basics of ARDS and evidence-based management. It reviews some specific features of obstetric physiology and fetal gas exchange that are important to keep in mind. Finally, we will review what guidance is available and review general recommendations for managing these patients in transport.
For additional learning and a more in-depth review of the evidence check out this talk on gas exchange and mechanical ventilation in critically ill patients by Dr. Allison Lankford (part of the amazing Maryland CC Project lecture series): http://maryland.ccproject.com/2023/05/30/lankford-gas-exchange-and-pulmonary-ventilation-in-the-critically-ill-obstetric-patient/
References
1. Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-x
2. Barrantes JH, Ortoleva J, O'Neil ER, et al. Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation. Asaio j. Feb 1 2021;67(2):132-136. doi:10.1097/mat.0000000000001357
3. Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol. Oct-Dec 2016;32(4):431-439. doi:10.4103/0970-9185.194779
4. Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol MFM. May 2020;2(2):100106. doi:10.1016/j.ajogmf.2020.100106
5. Campbell LA, Klocke RA. Implications for the pregnant patient. Am J Respir Crit Care Med. Apr 2001;163(5):1051-4. doi:10.1164/ajrccm.163.5.16353
6. Carter AM. Factors affecting gas transfer across the placenta and the oxygen supply to the fetus. J Dev Physiol. Dec 1989;12(6):305-22.
7. Carter AM. Placental Gas Exchange and the Oxygen Supply to the Fetus. Compr Physiol. Jul 1 2015;5(3):1381-403. doi:10.1002/cphy.c140073
8. Cavalcante FML, Fernandes CDS, Rocha LDS, Galindo-Neto NM, Caetano J, Barros LM. Use of the prone position in pregnant women with COVID-19 or other health conditions. Rev Lat Am Enfermagem. 2021;29:e3494. doi:10.1590/1518-8345.5181.3494
9. Cojocaru L, Turan OM, Levine A, et al. Proning modus operandi in pregnancies complicated by acute respiratory distress syndrome secondary to COVID-19. J Matern Fetal Neonatal Med. Dec 2022;35(25):9043-9052. doi:10.1080/14767058.2021.2013464
10. Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Acute respiratory distress syndrome in pregnancy. Crit Care Med. Oct 2005;33(10 Suppl):S269-78. doi:10.1097/01.ccm.0000182478.14181.da
11. D'Souza R, Ashraf R, Rowe H, et al. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol. Feb 2021;57(2):195-203. doi:10.1002/uog.23116
12. Danish MA. Mechanical Ventilation in Critically Ill Obstetric Patient. Principles of Critical Care in Obstetrics. 2016:133-141:chap Chapter 14.
13. Delyoa-Tomas E M-LT, Lopez-Fermin J, Perez-Nieto OR, et al. Consideration for Mechanical Ventilation in the Critically Ill Obstetric Patient. Crit Care Obst Gyne. 2020;6(10):1-8.
14. Douglass KM, Strobel KM, Richley M, et al. Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series. Am J Perinatol. Jan 2021;38(1):82-87. doi:10.1055/s-0040-1718694
15. Ende H, Varelmann D. Respiratory Considerations Including Airway and Ventilation Issues in Critical Care Obstetric Patients. Obstet Gynecol Clin North Am. Dec 2016;43(4):699-708. doi:10.1016/j.ogc.2016.07.002
16. Gattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486
17. Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
18. Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884
19. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103
20. Huang C-Y, Tsai Y-L, Lin C-K. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). Taiwanese Journal of Obstetrics and Gynecology. 2021/05/01/ 2021;60(3):574-576. doi:https://doi.org/10.1016/j.tjog.2021.03.036
21. Khalil M, Butt A, Kseibi E, Althenayan E, Alhazza M, Sallam H. COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State. Membranes (Basel). Jul 17 2021;11(7)doi:10.3390/membranes11070544
22. Kodali BS, Wong MJ, Lankford A, Lee K, Bharadwaj S. Effect of Fetal Delivery on Pao2/Fio2 Ratio During Mechanical Ventilation in Parturients With COVID-19: A Case Series. A A Pract. Jul 1 2022;16(7):e01587. doi:10.1213/xaa.0000000000001587
23. Lam GK, Stafford RE, Thorp J, Moise KJ, Jr., Cairns BA. Inhaled nitric oxide for primary pulmonary hypertension in pregnancy. Obstet Gynecol. Nov 2001;98(5 Pt 2):895-8. doi:10.1016/s0029-7844(01)01549-6
24. Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. Sep 2015;8(3):126-32. doi:10.1177/1753495X15589223
25. Lapinsky SE, Posadas-Calleja JG, McCullagh I. Clinical review: Ventilatory strategies for obstetric, brain-injured and obese patients. Crit Care. 2009;13(2):206. doi:10.1186/cc7146
26. Lapinsky SE, Viau-Lapointe J. Mechanical Ventilation and Delivery During Pregnancy. Chest. Mar 2023;163(3):473-474. doi:10.1016/j.chest.2022.10.025
27. Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Seminars in Fetal and Neonatal Medicine. 2023;28(1)doi:10.1016/j.siny.2023.101426
28. Linassi F, Campagnolo M, Busato E, Ortolani V, Peta M. Prolonged prone position in pregnant woman with COVID-19 pneumonia. Journal of Anesthesia, Analgesia and Critical Care. 2022/04/12 2022;2(1):16. doi:10.1186/s44158-022-00044-9
29. Lucarelli E, Behn C, Lashley S, Smok D, Benito C, Oyelese Y. Mechanical Ventilation in Pregnancy Due to COVID-19: A Cohort of Three Cases. Am J Perinatol. Aug 2020;37(10):1066-1069. doi:10.1055/s-0040-1713664
30. Magala Ssekandi A, Sserwanja Q, Olal E, Kawuki J, Bashir Adam M. Corticosteroids Use in Pregnant Women with COVID-19: Recommendations from Available Evidence. J Multidiscip Healthc. 2021;14:659-663. doi:10.2147/jmdh.S301255
31. Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. Jul 2015;29(5):598-611. doi:10.1016/j.bpobgyn.2015.04.005
32. Monsalve-Naharro J, Domingo-Chiva E, García Castillo S, Cuesta-Montero P, Jiménez-Vizuete JM. Inhaled nitric oxide in adult patients with acute respiratory distress syndrome. Farm Hosp. Mar 1 2017;41(2):292-312. Óxido nítrico inhalado en pacientes adultos con síndrome de distrés respiratorio agudo. doi:10.7399/fh.2017.41.2.10533
33. Naoum EE, Chalupka A, Haft J, et al. Extracorporeal Life Support in Pregnancy: A Systematic Review. J Am Heart Assoc. Jul 7 2020;9(13):e016072. doi:10.1161/jaha.119.016072
34. O'Neil ER, Lin H, Shamshirsaz AA, et al. Pregnant and Peripartum Women with COVID-19 Have High Survival with Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis. Am J Respir Crit Care Med. Jan 15 2022;205(2):248-250. doi:10.1164/rccm.202109-2096LE
35. Osmundo GS, Jr., Paganotti CF, da Costa RA, et al. Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome. Vaccines (Basel). Dec 19 2022;10(12)doi:10.3390/vaccines10122182
36. Oxford-Horrey C, Savage M, Prabhu M, et al. Putting It All Together: Clinical Considerations in the Care of Critically Ill Obstetric Patients with COVID-19. Am J Perinatol. Aug 2020;37(10):1044-1051. doi:10.1055/s-0040-1713121
37. Pacheco LD, Saade GR, Hankins GD. Mechanical ventilation during pregnancy: sedation, analgesia, and paralysis. Clin Obstet Gynecol. Dec 2014;57(4):844-50. doi:10.1097/grf.0000000000000064
38. PACHECO LD, SAADE GR, HANKINS GDV. Mechanical Ventilation During Pregnancy: Sedation, Analgesia, and Paralysis. Clinical Obstetrics and Gynecology. 2014;57(4):844-850. doi:10.1097/grf.0000000000000064
39. Pandya ST, Krishna SJ. Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med. Dec 2021;25(Suppl 3):S241-s247. doi:10.5005/jp-journals-10071-24036
40. Pineles BL, Stephens A, Narendran LM, et al. The relationship between delivery and the PaO(2) /FiO(2) ratio in COVID-19: a cohort study. Bjog. Feb 2022;129(3):493-499. doi:10.1111/1471-0528.16858
41. Qadir N, Sahetya S, Munshi L, et al. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. Jan 1 2024;209(1):24-36. doi:10.1164/rccm.202311-2011ST
42. Qian Y, Hao Y, Liu Y, et al. [Application of extracorporeal membrane oxygenation in critically ill pregnant women]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. May 2021;33(5):605-608. doi:10.3760/cma.j.cn121430-20201231-00784
43. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669
44. Ray BR, Trikha A. Prone Position Ventilation in Pregnancy: Concerns and Evidence. Journal of Obstetric Anaesthesia and Critical Care. 2018;8(1):7-9. doi:10.4103/joacc.JOACC_17_18
45. Rush B, Martinka P, Kilb B, McDermid RC, Boyd JH, Celi LA. Acute Respiratory Distress Syndrome in Pregnant Women. Obstet Gynecol. Mar 2017;129(3):530-535. doi:10.1097/aog.0000000000001907
46. Saad AF, Chappell L, Saade GR, Pacheco LD. Corticosteroids in the Management of Pregnant Patients With Coronavirus Disease (COVID-19). Obstetrics & Gynecology. 2020;136(4):823-826. doi:10.1097/aog.0000000000004103
47. Saad AF, Rahman M, Maybauer DM, et al. Extracorporeal Membrane Oxygenation in Pregnant and Postpartum Women With H1N1-Related Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis. Obstet Gynecol. Feb 2016;127(2):241-7. doi:10.1097/aog.0000000000001236
48. Safaee Fakhr B, Wiegand SB, Pinciroli R, et al. High Concentrations of Nitric Oxide Inhalation Therapy in Pregnant Patients With Severe Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. Dec 2020;136(6):1109-1113. doi:10.1097/aog.0000000000004128
49. Sebastian NA, Spence AR, Bouhadoun S, Abenhaim HA. Extracorporeal membrane oxygenation in pregnant and postpartum patients: a systematic review. J Matern Fetal Neonatal Med. Dec 2022;35(24):4663-4673. doi:10.1080/14767058.2020.1860932
50. Tavazzi G, Pozzi M, Mongodi S, Dammassa V, Romito G, Mojoli F. Inhaled nitric oxide in patients admitted to intensive care unit with COVID-19 pneumonia. Crit Care. Aug 17 2020;24(1):508. doi:10.1186/s13054-020-03222-9
51. Taylor RW, Zimmerman JL, Dellinger RP, et al. Low-dose inhaled nitric oxide in patients with acute lung injury: a randomized controlled trial. Jama. Apr 7 2004;291(13):1603-9. doi:10.1001/jama.291.13.1603
52. Tolcher MC, McKinney JR, Eppes CS, et al. Prone Positioning for Pregnant Women With Hypoxemia Due to Coronavirus Disease 2019 (COVID-19). Obstet Gynecol. Aug 2020;136(2):259-261. doi:10.1097/aog.0000000000004012
53. Troiano NH JT. Mechanical Ventilation During Pregnancy. In: Troiano NH HC, Chez BF, ed. High-Risk and Critical Care Obstetrics. 3rd ed. Lippincott Williams& Wilkins; 2013:48-59:chap 5.
54. van den Bosch OFC, Chaudhry R, Wicker J, et al. Predictors and Hospital Outcomes in Pregnant Patients Undergoing Extracorporeal Membrane Oxygenation: A Nationwide Study. Anesth Analg. Dec 1 2022;135(6):1172-1179. doi:10.1213/ane.0000000000006210
55. Wong MJ, Bharadwaj S, Lankford AS, Galey JL, Kodali BS. Mechanical ventilation and prone positioning in pregnant patients with severe COVID-19 pneumonia: experience at a quaternary referral center. Int J Obstet Anesth. Feb 2022;49:103236. doi:10.1016/j.ijoa.2021.103236
56. Yin O, Richley M, Hadaya J, et al. Extracorporeal membrane oxygenation in pregnancy: a bridge to delivery and pulmonary recovery for COVID-19-related severe respiratory failure. Am J Obstet Gynecol. Apr 2022;226(4):571-576.e5. doi:10.1016/j.ajog.2021.12.024
This is the sixth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams as a retrieval OBGYN/MFM and is one of our Assistant Medical Directors for the flight program.
The topic of this podcast is Mechanical Ventilation and ARDS in pregnancy. Although respiratory distress requiring intubation and ARDS in pregnancy is not very common, it is more common than some of the other pathologies we have discussed recently. Mechanical ventilation of the pregnant patient can be intimidating, but rest assured that if you have the capabilities to manage other patients on a vent, you can manage the pregnant patient. Generally speaking solid outcomes data is sparse and, generally speaking, most guidelines recommend vent management of mechanical ventilation in patients with or without ARDS similarly to non-pregnant patients…with a few exceptions. This podcast reviews the basics of ARDS and evidence-based management. It reviews some specific features of obstetric physiology and fetal gas exchange that are important to keep in mind. Finally, we will review what guidance is available and review general recommendations for managing these patients in transport.
For additional learning and a more in-depth review of the evidence check out this talk on gas exchange and mechanical ventilation in critically ill patients by Dr. Allison Lankford (part of the amazing Maryland CC Project lecture series): http://maryland.ccproject.com/2023/05/30/lankford-gas-exchange-and-pulmonary-ventilation-in-the-critically-ill-obstetric-patient/
References
1. Abou-Arab O, Huette P, Debouvries F, Dupont H, Jounieaux V, Mahjoub Y. Inhaled nitric oxide for critically ill Covid-19 patients: a prospective study. Crit Care. Nov 12 2020;24(1):645. doi:10.1186/s13054-020-03371-x
2. Barrantes JH, Ortoleva J, O'Neil ER, et al. Successful Treatment of Pregnant and Postpartum Women With Severe COVID-19 Associated Acute Respiratory Distress Syndrome With Extracorporeal Membrane Oxygenation. Asaio j. Feb 1 2021;67(2):132-136. doi:10.1097/mat.0000000000001357
3. Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol. Oct-Dec 2016;32(4):431-439. doi:10.4103/0970-9185.194779
4. Boelig RC, Saccone G, Bellussi F, Berghella V. MFM guidance for COVID-19. Am J Obstet Gynecol MFM. May 2020;2(2):100106. doi:10.1016/j.ajogmf.2020.100106
5. Campbell LA, Klocke RA. Implications for the pregnant patient. Am J Respir Crit Care Med. Apr 2001;163(5):1051-4. doi:10.1164/ajrccm.163.5.16353
6. Carter AM. Factors affecting gas transfer across the placenta and the oxygen supply to the fetus. J Dev Physiol. Dec 1989;12(6):305-22.
7. Carter AM. Placental Gas Exchange and the Oxygen Supply to the Fetus. Compr Physiol. Jul 1 2015;5(3):1381-403. doi:10.1002/cphy.c140073
8. Cavalcante FML, Fernandes CDS, Rocha LDS, Galindo-Neto NM, Caetano J, Barros LM. Use of the prone position in pregnant women with COVID-19 or other health conditions. Rev Lat Am Enfermagem. 2021;29:e3494. doi:10.1590/1518-8345.5181.3494
9. Cojocaru L, Turan OM, Levine A, et al. Proning modus operandi in pregnancies complicated by acute respiratory distress syndrome secondary to COVID-19. J Matern Fetal Neonatal Med. Dec 2022;35(25):9043-9052. doi:10.1080/14767058.2021.2013464
10. Cole DE, Taylor TL, McCullough DM, Shoff CT, Derdak S. Acute respiratory distress syndrome in pregnancy. Crit Care Med. Oct 2005;33(10 Suppl):S269-78. doi:10.1097/01.ccm.0000182478.14181.da
11. D'Souza R, Ashraf R, Rowe H, et al. Pregnancy and COVID-19: pharmacologic considerations. Ultrasound Obstet Gynecol. Feb 2021;57(2):195-203. doi:10.1002/uog.23116
12. Danish MA. Mechanical Ventilation in Critically Ill Obstetric Patient. Principles of Critical Care in Obstetrics. 2016:133-141:chap Chapter 14.
13. Delyoa-Tomas E M-LT, Lopez-Fermin J, Perez-Nieto OR, et al. Consideration for Mechanical Ventilation in the Critically Ill Obstetric Patient. Crit Care Obst Gyne. 2020;6(10):1-8.
14. Douglass KM, Strobel KM, Richley M, et al. Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series. Am J Perinatol. Jan 2021;38(1):82-87. doi:10.1055/s-0040-1718694
15. Ende H, Varelmann D. Respiratory Considerations Including Airway and Ventilation Issues in Critical Care Obstetric Patients. Obstet Gynecol Clin North Am. Dec 2016;43(4):699-708. doi:10.1016/j.ogc.2016.07.002
16. Gattinoni L, Camporota L, Marini JJ. Prone Position and COVID-19: Mechanisms and Effects. Crit Care Med. May 1 2022;50(5):873-875. doi:10.1097/ccm.0000000000005486
17. Grasselli G, Calfee CS, Camporota L, et al. ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies. Intensive Care Med. Jul 2023;49(7):727-759. doi:10.1007/s00134-023-07050-7
18. Griffiths MJ, Evans TW. Inhaled nitric oxide therapy in adults. N Engl J Med. Dec 22 2005;353(25):2683-95. doi:10.1056/NEJMra051884
19. Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. Jun 6 2013;368(23):2159-68. doi:10.1056/NEJMoa1214103
20. Huang C-Y, Tsai Y-L, Lin C-K. The prone position ventilation (PPV) as an approach in pregnancy with acute respiratory distress syndrome (ARDS). Taiwanese Journal of Obstetrics and Gynecology. 2021/05/01/ 2021;60(3):574-576. doi:https://doi.org/10.1016/j.tjog.2021.03.036
21. Khalil M, Butt A, Kseibi E, Althenayan E, Alhazza M, Sallam H. COVID-19-Related Acute Respiratory Distress Syndrome in a Pregnant Woman Supported on ECMO: The Juxtaposition of Bleeding in a Hypercoagulable State. Membranes (Basel). Jul 17 2021;11(7)doi:10.3390/membranes11070544
22. Kodali BS, Wong MJ, Lankford A, Lee K, Bharadwaj S. Effect of Fetal Delivery on Pao2/Fio2 Ratio During Mechanical Ventilation in Parturients With COVID-19: A Case Series. A A Pract. Jul 1 2022;16(7):e01587. doi:10.1213/xaa.0000000000001587
23. Lam GK, Stafford RE, Thorp J, Moise KJ, Jr., Cairns BA. Inhaled nitric oxide for primary pulmonary hypertension in pregnancy. Obstet Gynecol. Nov 2001;98(5 Pt 2):895-8. doi:10.1016/s0029-7844(01)01549-6
24. Lapinsky SE. Acute respiratory failure in pregnancy. Obstet Med. Sep 2015;8(3):126-32. doi:10.1177/1753495X15589223
25. Lapinsky SE, Posadas-Calleja JG, McCullagh I. Clinical review: Ventilatory strategies for obstetric, brain-injured and obese patients. Crit Care. 2009;13(2):206. doi:10.1186/cc7146
26. Lapinsky SE, Viau-Lapointe J. Mechanical Ventilation and Delivery During Pregnancy. Chest. Mar 2023;163(3):473-474. doi:10.1016/j.chest.2022.10.025
27. Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and Severe ARDS with COVID-19: Epidemiology, Diagnosis, Outcomes and Treatment. Seminars in Fetal and Neonatal Medicine. 2023;28(1)doi:10.1016/j.siny.2023.101426
28. Linassi F, Campagnolo M, Busato E, Ortolani V, Peta M. Prolonged prone position in pregnant woman with COVID-19 pneumonia. Journal of Anesthesia, Analgesia and Critical Care. 2022/04/12 2022;2(1):16. doi:10.1186/s44158-022-00044-9
29. Lucarelli E, Behn C, Lashley S, Smok D, Benito C, Oyelese Y. Mechanical Ventilation in Pregnancy Due to COVID-19: A Cohort of Three Cases. Am J Perinatol. Aug 2020;37(10):1066-1069. doi:10.1055/s-0040-1713664
30. Magala Ssekandi A, Sserwanja Q, Olal E, Kawuki J, Bashir Adam M. Corticosteroids Use in Pregnant Women with COVID-19: Recommendations from Available Evidence. J Multidiscip Healthc. 2021;14:659-663. doi:10.2147/jmdh.S301255
31. Mehta N, Chen K, Hardy E, Powrie R. Respiratory disease in pregnancy. Best Pract Res Clin Obstet Gynaecol. Jul 2015;29(5):598-611. doi:10.1016/j.bpobgyn.2015.04.005
32. Monsalve-Naharro J, Domingo-Chiva E, García Castillo S, Cuesta-Montero P, Jiménez-Vizuete JM. Inhaled nitric oxide in adult patients with acute respiratory distress syndrome. Farm Hosp. Mar 1 2017;41(2):292-312. Óxido nítrico inhalado en pacientes adultos con síndrome de distrés respiratorio agudo. doi:10.7399/fh.2017.41.2.10533
33. Naoum EE, Chalupka A, Haft J, et al. Extracorporeal Life Support in Pregnancy: A Systematic Review. J Am Heart Assoc. Jul 7 2020;9(13):e016072. doi:10.1161/jaha.119.016072
34. O'Neil ER, Lin H, Shamshirsaz AA, et al. Pregnant and Peripartum Women with COVID-19 Have High Survival with Extracorporeal Membrane Oxygenation: An Extracorporeal Life Support Organization Registry Analysis. Am J Respir Crit Care Med. Jan 15 2022;205(2):248-250. doi:10.1164/rccm.202109-2096LE
35. Osmundo GS, Jr., Paganotti CF, da Costa RA, et al. Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome. Vaccines (Basel). Dec 19 2022;10(12)doi:10.3390/vaccines10122182
36. Oxford-Horrey C, Savage M, Prabhu M, et al. Putting It All Together: Clinical Considerations in the Care of Critically Ill Obstetric Patients with COVID-19. Am J Perinatol. Aug 2020;37(10):1044-1051. doi:10.1055/s-0040-1713121
37. Pacheco LD, Saade GR, Hankins GD. Mechanical ventilation during pregnancy: sedation, analgesia, and paralysis. Clin Obstet Gynecol. Dec 2014;57(4):844-50. doi:10.1097/grf.0000000000000064
38. PACHECO LD, SAADE GR, HANKINS GDV. Mechanical Ventilation During Pregnancy: Sedation, Analgesia, and Paralysis. Clinical Obstetrics and Gynecology. 2014;57(4):844-850. doi:10.1097/grf.0000000000000064
39. Pandya ST, Krishna SJ. Acute Respiratory Distress Syndrome in Pregnancy. Indian J Crit Care Med. Dec 2021;25(Suppl 3):S241-s247. doi:10.5005/jp-journals-10071-24036
40. Pineles BL, Stephens A, Narendran LM, et al. The relationship between delivery and the PaO(2) /FiO(2) ratio in COVID-19: a cohort study. Bjog. Feb 2022;129(3):493-499. doi:10.1111/1471-0528.16858
41. Qadir N, Sahetya S, Munshi L, et al. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. Jan 1 2024;209(1):24-36. doi:10.1164/rccm.202311-2011ST
42. Qian Y, Hao Y, Liu Y, et al. [Application of extracorporeal membrane oxygenation in critically ill pregnant women]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. May 2021;33(5):605-608. doi:10.3760/cma.j.cn121430-20201231-00784
43. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. Jama. Jun 20 2012;307(23):2526-33. doi:10.1001/jama.2012.5669
44. Ray BR, Trikha A. Prone Position Ventilation in Pregnancy: Concerns and Evidence. Journal of Obstetric Anaesthesia and Critical Care. 2018;8(1):7-9. doi:10.4103/joacc.JOACC_17_18
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