Maternal oxygenation and fetal-neonatal mortality among patients with COVID-19 requiring advanced respiratory support in ICU: A multicenter prospective cohort study.

Autor: Vasquez DN; Sanatorio Anchorena, Buenos Aires, Argentina., Giannoni R; Hospital Regional Ramón Carrillo, Santiago del Estero, Argentina., Salvatierra A; Hospital del Este 'Eva Perón', San Miguel de Tucumán, Banda del Río Salí, Tucumán, Argentina., Cisneros K; Sanatorio Antártida, Buenos Aires, Argentina., Lafosse D; Hospital Materno Infantil Dr. F Escardó, Tigre, Buenos Aires, Argentina., Escobar MF; Fundación Valle del Lili, Cali, Colombia., Montenegro M; Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina., Juárez P; Hospital de la Madre y el Niño, La Rioja, Argentina., Visani L; Hospital Cuenca Alta Néstor Kirchner, Cañuelas, Buenos Aires, Argentina., Mandich V; Hospital Santojanni, Buenos Aires, Argentina., Barrozo E; Maternidad Provincial Teresita Baigorria, San Luis, Argentina., Kirschbaum M; Sanatorio Finochietto, Buenos Aires, Argentina., Das Neves AV; Hospital Interzonal General de Agudos Gral, San Martín, La Plata, Buenos Aires, Argentina., Valenti MF; Argentine Society of Critical Care Medicine, Buenos Aires, Argentina., Canseco MC; Instituto de Maternidad y Ginecología nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán, Argentina., Romero I; Sanatorio Güemes, Buenos Aires, Argentina., Macharé P; Hospital Mi Pueblo, Florencio Varela, Buenos Aires, Argentina., Marquez AK; Hospital Municipal de Morón, Morón, Buenos Aires, Argentina., Rodriguez E; Hospital Simplemente Evita, González Catán, Buenos Aires, Argentina., Palacio C; Sanatorio Itoiz, Avellaneda, Buenos Aires, Argentina., Rapela L; Hospital Municipal del Carmen, Buenos Aires, Argentina., Amillategui Scenna JM; Hospital Provincial del Centenario, Rosario, Santa Fé, Argentina., Nuñez R; Hospital Mariano y Luciano de la Vega, Moreno, Buenos Aires, Argentina., Torres S; Sanatorio Anchorena San Martín, San Martín, Buenos Aires, Argentina., González MA; Hospital del Este 'Eva Perón', San Miguel de Tucumán, Banda del Río Salí, Tucumán, Argentina., Franconieri L; Sanatorio Antártida, Buenos Aires, Argentina., Nasner D; Fundación Valle del Lili, Cali, Colombia., Okurzaty P; Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina., Plotnikow GA; Sanatorio Anchorena, Buenos Aires, Argentina., Intile AD; Sanatorio Anchorena, Buenos Aires, Argentina.
Jazyk: angličtina
Zdroj: International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics [Int J Gynaecol Obstet] 2024 Dec 05. Date of Electronic Publication: 2024 Dec 05.
DOI: 10.1002/ijgo.16046
Abstrakt: Objective: To explore the association of maternal characteristics, oxygenation, and mechanical ventilatory parameters with fetal and neonatal outcomes.
Methods: The present study was a multicenter, binational (Argentina/Colombia), prospective, cohort study, conducted in 21 intensive care units (ICUs) and including pregnant or postpartum patients with COVID-19 pneumonia requiring advanced respiratory support and their fetuses/neonates. Advanced respiratory support was defined as high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or invasive mechanical ventilation (IMV).
Results: A total of 91 patients were admitted to 21 ICUs: 63 (69%) antepartum and 28 (31%) postpartum. Among those admitted antepartum (63), delivery was induced in 43 (68.3%), being the reasons mostly maternal (28/43; 65.1%). Of 71 births, 64 (90%) were preterm. A total of 14 fetal/neonatal losses (14/91;15.4%) occurred. The main differences between patients whose fetuses/neonates survived versus those who did not survive were in APACHE II (12 [7-15] vs. 16.5 [14-20]; P = 0.003), SOFA 24 (4 [3-5] vs. 6.5 [5-8]; P = 0.001), gestational age at delivery (32.9 ± 3 vs. 27.6 ± 6.2; P = 0.014), acute respiratory distress syndrome (54 [70.1%] vs. 14 [100%]; P = 0.011), septic shock (26 [33.8%] vs. 9 [64.3%]; P = 0.031), IMV (55 [71.4%] vs. 14 [100%]; P = 0.019) and plateau pressure before delivery (23 [21-26] vs. 28 [27-30]; P = 0.019). The incidence of fetal/neonatal mortality among 47 pregnant patients requiring IMV with SpO 2  < 95% versus SpO 2 >95% before intubation was 12/35 (34.28%) versus 1/12 (8.33%), respectively; P = 0.163. The incidence of fetal/neonatal mortality among those with SpO 2 <95% versus SpO 2 >95% before delivery was 5/18 (27.77%) versus 8/29 (25.58%), respectively; P = 0.999.
Conclusion: The vast majority of births were preterm. Among patients admitted antepartum, most deliveries were induced for maternal reasons. Fetal/neonatal losses were associated with gestational age at delivery, maternal severity of illness on admission and certain ventilatory parameters but not with maternal oxygenation, as is commonly the focus in these patients.
(© 2024 International Federation of Gynecology and Obstetrics.)
Databáze: MEDLINE
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