Management of pregnant women in tertiary maternity hospitals in the Paris area referred to the intensive care unit for acute hypoxaemic respiratory failure related to SARS-CoV-2: which practices for which outcomes?
Authors' conclusion
In pregnant women with AHRF related to SARS-CoV-2, HFNO and non-invasive mechanical ventilation were associated with a reduced rate of intubation, while pulmonary co-infection was associated with an increased rate. Pregnancy was continued on invasive mechanical ventilation in one-third of intubated women.
Study context
- Population
- Pregnant women admitted to 15 ICUs of tertiary maternity hospitals, Paris area, with acute hypoxaemic respiratory failure (AHRF) related to SARS-CoV-2 (O2 ≥ 6 L/min, high-flow nasal oxygen (HFNO), NIV or invasive ventilation)
- Participants
- 107 women · 15 ICUs
- Exposure
- Respiratory support: HFNO vs NIV vs standard O2
- Standard O2n = 19reference
- NIVn = 36
- HFNOn = 52
- Outcome
- Need for intubation
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Intubation
Each group vs standard O2Adjusted odds ratio (CI)
HFNO
0.11(0.02–0.41)
NIV
0.20(0.04–0.80)
- Intubation overall
- 47/107 (44%)
Observational data: associations, not effects.
Further findings
Pulmonary co-infection and intubation
| aOR (95% CI) | ||
|---|---|---|
| Pulmonary co-infection | 3.38 (1.31–9.21) | |
| 0.10.31310Adjusted odds ratio (log scale) |
Delivery during ICU stay
- Delivered during ICU stay
- 46 (43%)
- For maternal pulmonary worsening
- 39/46 (85%)
- At a preterm stage
- 41/46 (89%)
- Non-intubated delivered under RA, later requiring emergency intubation
- 9/14
Trajectories
- Delivered within 2 days of ICU admission while not intubated
- 19
- Delivered within 2 days after intubation
- 23
- Intubated with pregnancy continued; delivery after ICU discharge in 8/11
- 11
- Never intubated
- 54
Maternal and foetal death
- Maternal death
- 1
- Foetal death
- 1
Original publication
Management of pregnant women in tertiary maternity hospitals in the Paris area referred to the intensive care unit for acute hypoxaemic respiratory failure related to SARS-CoV-2: which practices for which outcomes? Ann Intensive Care. Published 18 June 2024. doi:10.
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