A nationwide cohort study of pregnant and postpartum patients with severe COVID-19 pneumonitis in ICU in Israel
Critical Care Conference: 42nd International Symposium on Intensive Care and Emergency Medicine Brussels Belgium
; 27(Supplement 1), 2023.
Artigo
em Inglês
| EMBASE | ID: covidwho-2314457
ABSTRACT
Introduction:
This study included pregnant patients with severe COVID to test the hypothesis that the impact of delivery on maternal outcome depends upon illness severity at the time of delivery;we hypothesized that patients not yet requiring IPPV would improve following delivery (due to improvement in respiratory mechanics), while patients already on IPPV, or close to requiring ventilation, would deteriorate (due to maternal cardiovascular intolerance to autotransfusion). Method(s) This multicenter, prospective/retrospective cohort study evaluated Israeli ICU admissions of pregnant women with COVID-19 pneumonitis from 1-Feb-2020 to 31-Jan-2022. We assessed maternal, neonatal outcomes and longitudinal maternal clinical data. The primary outcome was maternal outcome (no-IPPV, IPPV, ECMO, death). The primary longitudinal outcome was SOFA score, the secondary longitudinal outcome was the novel PORCH score (PEEP, Oxygenation, Respiratory-support, Chest-X-ray, Haemodynamic-support). Patients were classified into no-delivery, postpartum admission, deliverycritical and delivery-not-critical groups. Result(s) 84 patients in 13 ICUs were analysed;there were 34 nodelivery, 4 postpartum, 32 delivery-critical, 14 delivery-not-critical patients. Delivery-critical and postpartum had worse outcomes with, 26/32(81%) and 4/4(100%) requiring IPPV;12/32(38%) and 3/4(75%) requiring ECMO;1/32(3%) and 2/4(50%) dying. Deliverynot- critical and no-delivery had far better outcomes with, respectively, 6/34(18%) and 2/14(14%) requiring mechanical ventilation;no patients required ECMO or died. SpO2, S/F ratio, P/F ratio in Deliverycritical deteriorated on the day of delivery, continued to deteriorate, and took longer to recover;delivery-not-critical improved rapidly following delivery. The day of delivery was a highly significant covariate for PORCH (p < 0.0001), not SOFA (p = 0.09). Conclusion(s) Interventional delivery should be considered for maternal indications before patients deteriorate and require IPPV.
adult; artificial ventilation; assisted ventilation; blood autotransfusion; breathing mechanics; clinical assessment; cohort analysis; conference abstract; controlled study; coronavirus disease 2019; female; hemodynamics; Horowitz index; human; intermittent positive pressure ventilation; Israel; major clinical study; multicenter study; obstetric delivery; outcome assessment; oxygenation; pneumonia; positive end expiratory pressure ventilation; pregnancy; pregnant woman; prospective study; retrospective study; Sequential Organ Failure Assessment Score; thorax radiography
Texto completo:
Disponível
Coleções:
Bases de dados de organismos internacionais
Base de dados:
EMBASE
Tipo de estudo:
Estudo de coorte
/
Estudo observacional
/
Estudo prognóstico
Idioma:
Inglês
Revista:
Critical Care Conference: 42nd International Symposium on Intensive Care and Emergency Medicine Brussels Belgium
Ano de publicação:
2023
Tipo de documento:
Artigo
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