TITLE:
Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series
AUTHORS:
Carlos Montufar-Rueda, Agnès Ditisheim, Alfredo F. Gei, Rolando Pinilla, Eddie Dinh, Jair Vélez, Brenda Castillo, Luis Farias
KEYWORDS:
Respiratory Support during Pregnancy, ARDS in Pregnancy, ALI in Pregnancy, Ventilatory Support, Non-Invasive Positive Pressure Ventilation
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.10 No.11,
November
16,
2020
ABSTRACT: Rationale: Acute respiratory failure is an uncommon complication of pregnancy.
However, it is the most frequent organ dysfunction associated with obstetric
admissions to an intensive care unit. The obstetric population is a different
group due to its physiology and the presence of the fetus that lacks evidence
in the literature within the subject of ventilatory support. Noninvasive
positive pressure ventilation (NIPPV) is often avoided due to the lack of
knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in
pregnancy. Objectives: To provide evidence in support of the use of
NIPPV as a safe and reasonable modality for pregnant patients with respiratory
failure. Methods: We retrospectively reviewed medical records of 29
pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in
Panamá City who received NIPPV from 2013 to 2015. Failure to response was
defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics,
indication for NIPPV, duration of treatment, as well as maternal and fetal
outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean
gestational age at admission was 305/7 ± 5 weeks. Twenty-four
patients (82.8%) met the criteria for acute lung injury (ALI) and an additional
two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of
ventilation was 50.6 ± 17.27 hours. Statistically significant differences were
noted between the paO2/FiO2 ratios in failure and successful patients
within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the
patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond
to NIPPV and needed to be converted to invasive mechanical ventilation. Patients
who required intubation had a longer duration of ICU stay (P = 0.006) and
overall hospital stay (P = 0.03). None of patients presented aspiration during
NIPPV therapy. Conclusion: The
current series is the largest report of pregnant patients requiring ventilatory
support who received NIPPV as first line of therapy. This report shows the
usefulness of this ventilation modality, avoiding intubation with its risks, of
a significant number of patients, especially ventilator-associated pneumonia.