| Autor: |
Péju, Edwige, Belicard, Félicie, Silva, Stein, Hraiech, Sami, Painvin, Benoît, Kamel, Toufik, Thille, Arnaud W., Goury, Antoine, Grimaldi, David, Jung, Boris, Piagnerelli, Michael, Winiszewski, Hadrien, Jourdain, Merce, Jozwiak, Mathieu, the COVIDPREG Study Group, Argaud, Laurent, Aubron, Cécile, Bèle, Nicolas, Beloncle, François, Bertrand, Pierre-Marie |
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| Zdroj: |
Intensive Care Medicine; Sep2022, Vol. 48 Issue 9, p1185-1196, 12p, 3 Charts, 3 Graphs |
| Abstrakt: |
Purpose: Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated.Methods: A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported.Results: Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks' gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05-3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02-1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30-5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09-3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support.Conclusion: In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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Full text from SpringerLink