Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study
Authors' conclusion
Delivery was induced mainly for maternal reasons, but did not change ventilatory parameters other than Pao2 to Fio2 ratio.
Study context
- Population
- Pregnant and postpartum patients with COVID-19 requiring advanced ventilatory support in the ICU
- Participants
- 91 participants · 21 ICUs
- Exposure
- Ventilatory parameters before vs after delivery
- Outcome
- Ventilatory parameters and impact of delivery on them
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Respiratory parameters before and after delivery
| Group | Value | Plateau pressure | Driving pressure | Median static compliance | PaO2/FiO2 |
|---|---|---|---|---|---|
| Before delivery | mean 25.6 (SD 6.6) cm H2O | 25.6 ± 6.6 cm H2O | 13.6 ± 4.2 cm H2O | 28 mL/cm H2O (IQR, 22.5-39) | 134 (IQR, 100-230) |
| After delivery ≤ 2 h | mean 24 (SD 6.7) cm H2O | 24 ± 6.7 cm H2O | 12.9 ± 3.9 cm H2O | 30 mL/cm H2O (IQR, 24.5-44) | 168 (IQR, 136-185) |
| After delivery 24 h | mean 24.6 (SD 5.2) cm H2O | 24.6 ± 5.2 cm H2O | 13 ± 4.4 cm H2O | 30 mL/cm H2O (IQR, 24.5-44) | 192 (IQR, 132-232.5) |
Value
Before deliverymean 25.6 (SD 6.6) cm H2O
After delivery ≤ 2 hmean 24 (SD 6.7) cm H2O
After delivery 24 hmean 24.6 (SD 5.2) cm H2O
Plateau pressure
Before delivery25.6 ± 6.6 cm H2O
After delivery ≤ 2 h24 ± 6.7 cm H2O
After delivery 24 h24.6 ± 5.2 cm H2O
Driving pressure
Before delivery13.6 ± 4.2 cm H2O
After delivery ≤ 2 h12.9 ± 3.9 cm H2O
After delivery 24 h13 ± 4.4 cm H2O
Median static compliance
Before delivery28 mL/cm H2O (IQR, 22.5-39)
After delivery ≤ 2 h30 mL/cm H2O (IQR, 24.5-44)
After delivery 24 h30 mL/cm H2O (IQR, 24.5-44)
PaO2/FiO2
Before delivery134 (IQR, 100-230)
After delivery ≤ 2 h168 (IQR, 136-185)
After delivery 24 h192 (IQR, 132-232.5)
- Plateau pressure across time points
- P = 0.59
- Driving pressure across time points
- P = 0.69
- Static compliance across time points
- P = 0.058
- PaO2/FiO2 across time points
- P = 0.022
Observational data: associations, not effects.
Further findings
Risk factor for invasive mechanical ventilation (IMV): SOFA24 score
| OR (95% CI) | P value | ||
|---|---|---|---|
| SOFA24 scoreOnly risk factor | 1.97 (1.29–2.99) | P = 0.001 | |
| 0.20.5125Odds ratio (log scale) |
Risk factors for maternal mortality
| OR (95% CI) | P value | ||
|---|---|---|---|
| BMI | 1.10 (1.006–1.204) | P = 0.037 | |
| Comorbidities | 4.15 (1.212–14.20) | P = 0.023 | |
| 0.050.21520Odds ratio (log scale) |
Risk factors for fetal or neonatal mortality
| OR (95% CI) | P value | ||
|---|---|---|---|
| Gestational age at delivery | 0.67 (0.52–0.86) | P = 0.002 | |
| SOFA24 score | 1.53 (1.13–2.08) | P = 0.006 | |
| 0.512Odds ratio (log scale) |
Respiratory parameters at IMV onset (pregnant patients)
- Plateau pressure, mean ± SD
- 24.3 ± 4.5 cm H2O
- Driving pressure, mean ± SD
- 12.5 ± 3.3 cm H2O
- Median static compliance
- 31 mL/cm H2O (IQR, 26-40)
- Median PaO2/FiO2
- 142 (IQR, 110-176)
Maximal ventilatory support
- IMV
- 69 (76%)
- HFNC
- 20 (22%)
- NIV
- 2 (2%)
- 63 (69%) delivered in ICU
Reasons for induced delivery
- Maternal
- 43 of 71 (60.5%)
- Maternal and fetal
- 21 of 71 (29.5%)
- Fetal
- 7 of 71 (9.9%)
- Continued pregnancy after ICU discharge
- 14 (22.2%)
Original publication
Ventilatory Parameters in Obstetric Patients With COVID-19 and Impact of Delivery: A Multicenter Prospective Cohort Study. Chest. Published 17 October 2022. doi:10.
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