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[Pregnant women with COVID-19 ARDS on the intensive care unit].
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- Author(s): Kalbhenn J;Kalbhenn J; Marx O; Marx O; Müller-Peltzer K; Müller-Peltzer K; Kunze M; Kunze M; Bürkle H; Bürkle H; Bansbach J; Bansbach J
- Source:
Die Anaesthesiologie [Anaesthesiologie] 2024 Jun; Vol. 73 (6), pp. 385-397. Date of Electronic Publication: 2024 Apr 26.- Publication Type:
English Abstract; Journal Article- Language:
German - Source:
- Additional Information
- Transliterated Title: Die Schwangere mit COVID-19-ARDS auf der Intensivstation.
- Source: Publisher: Springer Medizin Country of Publication: Germany NLM ID: 9918384886806676 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2731-6866 (Electronic) Linking ISSN: 27316858 NLM ISO Abbreviation: Anaesthesiologie Subsets: MEDLINE
- Publication Information: Original Publication: [Heidelberg, Germany] : Springer Medizin, [2022]-
- Subject Terms: COVID-19*/therapy ; COVID-19*/epidemiology ; COVID-19*/complications ; Pregnancy Complications, Infectious*/therapy ; Pregnancy Complications, Infectious*/virology ; Extracorporeal Membrane Oxygenation*/methods ; Intensive Care Units* ; Respiratory Distress Syndrome*/therapy ; Respiratory Distress Syndrome*/virology; Humans ; Female ; Pregnancy ; Adult ; Infant, Newborn ; Critical Care/methods ; Cesarean Section ; Germany/epidemiology ; Cohort Studies ; Pregnancy Outcome/epidemiology
- Abstract: Background: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues.
Objective: Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS).
Material and Methods: We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021.
Results: The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a Pa O2 /Fi O2 index < 150 mm Hg despite escalated invasive ventilation (Fi O2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth.
Conclusion: High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.
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Local Abstract: [Publisher, German] HINTERGRUND: Schwangere mit einer SARS-CoV-2-Infektion (COVID-19) haben ein erhöhtes Risiko für einen schweren Verlauf der COVID-19. Die medizinische und ethische Abwägung maternaler und fetaler Risiken und die Priorisierung von Therapieoptionen stellen eine große Herausforderung auf der Intensivstation dar. Eine enge interdisziplinäre Abstimmung ist unabdingbar. [Publisher, German] Beschreibung und Diskussion intensivmedizinischer Behandlungsstrategien und des perinatalen anästhesiologischen Managements bei Patientinnen mit COVID-19-ARDS (CARDS). [Publisher, German] Analyse von demografischen Daten, Anamnese, klinischem Management, Komplikationen, Indikationen und Management der extrakorporalen Membranoxygenierung (ECMO) sowie des kindlichen Überlebens aller schwangeren Patientinnen, die zwischen März und November 2021 auf der anästhesiologischen Intensivstation eines deutschen Universitätsklinikums wegen eines schweren CARDS behandelt wurden. [Publisher, German] Kohorte von 9 konsekutiven Patientinnen mit einem Durchschnittsalter von 30,3 Jahren (Min–Max: 26 bis 40 Jahre) und einem Schwangerschaftsalter von 21 + 3 bis 37 + 2 Wochen. Keine der Patientinnen war gegen SARS-CoV‑2 geimpft. Zwei Patientinnen mussten mit inhalativem Stickstoffmonoxid und venovenöser ECMO behandelt werden. Alle Frauen und 5 Neugeborene haben überlebt. Zwei Patientinnen wurden mit intakter Schwangerschaft nach Hause entlassen. Alle Kinder wurden durch einen Kaiserschnitt entbunden. Es wurden 2 intrauterine fetale Todesfälle beobachtet. Keines der Neugeborenen wurde bei der Geburt positiv auf SARS-CoV‑2 getestet. [Publisher, German] Das peripartale Management erfordert eine enge interdisziplinäre Zusammenarbeit und sollte in der Frühschwangerschaft vorrangig auf das mütterliche Überleben ausgerichtet sein. Die Bauchlagerung, ein wesentlicher, evidenzbasierter Eckpfeiler in der Therapie des akuten Atemnotsyndroms (ARDS), kann auch in fortgeschrittenen Schwangerschaftsstadien sicher angewendet werden. Inhalatives Stickstoffmonoxid (iNO) und extrakorporale Membranoxygenierung (ECMO) sollten als lebensrettende Behandlungsoptionen für sorgfältig ausgewählte Patientinnen in Betracht gezogen werden. - Publication Date: Date Created: 20240426 Date Completed: 20240610 Latest Revision: 20240819
- Publication Date: 20240819
- Accession Number: PMC11164748
- Accession Number: 10.1007/s00101-024-01405-5
- Accession Number: 38671334
- Transliterated Title:
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