///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

NON INVASIVE MECHANICAL VENTILATION FOR THE TREATMENT OF FOUR PREGNANT PATIENTS WITH ACUTE RESPIRATORY FAILURE.

Abstract Number: 237
Abstract Type: Case Report/Case Series

German Monsalve Mejia Anesthesiologist1 ; Tatiana Gallo Anesthesiologist2; Maria Virginia Gonzalez Anesthesiologist3; Jorge Rubio Anesthesiologist4; Juan Castillo Anesthesiologist5; Leonardo Mojica Anesthesiologist6

INTRODUCTION:

Non-invasive mechanical ventilation (NIMV) has been increasingly used to avoid intubation. There are few reports of uses of NIMV in the pregnant patient; we report 4 cases in which NIMV was used with the aim of avoiding tracheal intubation in hypoxemic ventilator failure.

METHODS:

Patients with ARDS defined radiologically and PaO2/FiO2 ratio < 200 were transferred to the OHDU to follow the NIMV protocol.

1.Head of the bed at a 45 angle with continuous fetal monitoring

2.Ventilation was initiate throw a full-face mask with an inflatable soft cushion seal.

3.Ventilator settings: CPAP and pressure support mode with increases of 2-3 cm H2O to obtain a tidal expiratory volume of 6 ml/kg. PEEP was increased from 2-3 cm H2O maximum 12 cm H2O, trying to use the lowest FiO2 to obtain an O2Sat > 92% and a respiratory rate of < 25 per minute. Arterial blood gases at the beginning and an hour latter were done. Oxygenation improvement was defined as a PaO2/FIO2 ratio> 200 or an increase of at least > 100. Need for intubation was defined as non improvement in oxygenation or respiratory work or a non reassuring fetal state(NRFS) was detected

RESULTS:

Demographic data are shown in table1. All patients had preterm pregnancies. ARDS causes were urinary sepsis and confirmed infection for influenza AH1N1 in two patient. The patients adapted well to NIMV. Figure 2 shows behavior of PaO2/FIO2 in time; in patient # 4 proposed goals were not achieved. She needs tracheal intubation and a NRFS were observed in fetal monitoring; she required a CS under general anesthesia and invasive mechanical ventilation for 72 hours.

DISCUSION

NIMV in severe hypoxemia (PA/FI ratio<200) and absence of hypercapnic respiratory failure (PCO2>45mmHg, pH<7.35) is controversial. The theoretical risk of broncoaspiracion exists over the 20 weeks of pregnancy. We report 3 out of four patients that achieved an improvement in oxygenation, the initial cause of respiratory failure was controlled and gestation continued to a term pregnancy; in one patient, the goals were not achieved in the short term and invasive mechanical ventilation was necessary developing severe hypoxemia with difficult ventilation as it is described in the obstetric population. The decision of tracheal intubation must be taken early in patients that after the implementation of NIMV show no improvement in oxygenation in order to lower the chances of fetal deterioration.

RERERENCES: Lancet 2009 Jul 18;374-250



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