Awake prone positioning and oxygen therapy in patients with COVID-19: the APRONOX study.

BACKGROUND: The awake prone positioning strategy for patients with acute respiratory distress syndrome is a safe, simple and cost-effective technique used to improve hypoxaemia. We aimed to evaluate intubation and mortality risk in patients with coronavirus disease 2019 (COVID-19) who underwent awake prone positioning during hospitalisation. METHODS: In this retrospective, multicentre observational study conducted between 1 May 2020 and 12 June 2020 in 27 hospitals in Mexico and Ecuador, nonintubated patients with COVID-19 managed with awake prone or awake supine positioning were included to evaluate intubation and mortality risk through logistic regression models; multivariable and centre adjustment, propensity score analyses, and E-values were calculated to limit confounding. RESULTS: 827 nonintubated patients with COVID-19 in the awake prone (n=505) and awake supine (n=322) groups were included for analysis. Fewer patients in the awake prone group required endotracheal intubation (23.6% versus 40.4%) or died (19.8% versus 37.3%). Awake prone positioning was a protective factor for intubation even after multivariable adjustment (OR 0.35, 95% CI 0.24-0.52; p<0.0001, E=2.12), which prevailed after propensity score analysis (OR 0.41, 95% CI 0.27-0.62; p<0.0001, E=1.86) and mortality (adjusted OR 0.38, 95% CI 0.26-0.55; p<0.0001, E=2.03). The main variables associated with intubation among awake prone patients were increasing age, lower baseline peripheral arterial oxygen saturation/inspiratory oxygen fraction ratio (P aO2 /F IO2 ) and management with a nonrebreather mask. CONCLUSIONS: Awake prone positioning in hospitalised nonintubated patients with COVID-19 is associated with a lower risk of intubation and mortality.

New-onset microscopic polyangiitis temporally associated with severe COVID-19 infection: A case report.

The coronavirus disease 2019 has been demonstrated to be a trigger for multiple immune-mediated diseases, such as antineutrophil cytoplasmic antibody-associated vasculitis. Associated vasculitis consists of rare autoimmune disorders that predominantly affect small vessels, leading to endothelial injury and tissue damage. We present a case of a newly diagnosed microscopic polyangiitis temporally associated with coronavirus disease 2019 infection in a previously healthy woman and a literature review. A 66-year-old female presented to the Emergency Room with fever, edema on her legs, productive cough, dyspnea, and hemoptysis. A chest computerized tomography scan revealed bilateral diffuse alveolar opacities with the appearance of diffuse alveolar hemorrhage. Blood analysis revealed a moderate normocytic, normochromic anemia with a hemoglobin of 6.6 g/dL, platelet count of 347 k/dL, leucocytes of 12,000/dL, a creatinine of 3.91 mg/dL (basal Cr: 0.9 mg/dL), and a Blood Urine Nnitrogen of 78 mg/dL. A urine sediment demonstrated glomerular hematuria, with mixed shapes of red blood cells. She was admitted to the intensive care unit and a bedside bronchoscopy revealed progressive bleeding with a bronchioalveolar lavage positive for diffuse alveolar hemorrhage. Given the critical involvement of the lungs and kidney function, the diagnostic approach revealed a positive p-anti-neutrophil cytoplasmic antibody on immunofluorescence and an anti-MPO (myeloperoxidase) level of 124.6 IU/mL. A renal biopsy demonstrated pauciimmune focal and segmental glomerulosclerosis. A diagnosis of microscopic polyangiitis triggered by severe acute respiratory syndrome coronavirus 2 infection was made, and immediate treatment with pulse-dose steroids and cyclophosphamide was initiated. The patient needed renal replacement therapy and was discharged for follow-up with nephrology and rheumatology services. The diagnostic approach of associated vasculitis can be more challenging in the coronavirus disease era. Atypical features in the pulmonary imaging and a rapid deterioration of the renal function should arise the clinical suspicion of the presence of an added condition to the coronavirus disease infection. Autoimmune conditions such as associated vasculitis should be evaluated even in the absence of previous autoimmune history. Prompt diagnosis and treatments must be prioritized to avoid end-organ definite damage. Further, larger and more collaborative studies are needed to confirm the potential role of coronavirus disease 2019 as a trigger of associated vasculitis.

A case report of atypical preeclampsia with severity criteria for hydatidiform complete mole.

Preeclampsia is defined as elevation of blood pressure and any of the following severity criteria: proteinuria, thrombocytopenia, elevation of creatinine in the absence of another renal pathology, elevation of transaminases, pulmonary edema, or neurological symptoms. However, after 20 weeks of gestation in a previously normotensive patient, cases of preeclampsia associated with molar pregnancy have been described in patients at less than 20 weeks of gestation. A 26-year-old woman, at 14.1 weeks of gestation was admitted to the lower extremities with facial edema, holocranial headache, nausea, epigastralgia, phosphenes, and photophobia, with a double-length uterine fundus for gestational age and ultrasonography. Obstetricians who showed images of snowflakes without fetuses and annexes had multiple thecal-lutein cysts. Atypical preeclampsia was identified using the severity data for complete hydatidiform moles. Given the possibility of serious complications that may endanger the life of the maternal-fetal binomial, atypical forms of preeclampsia should be suspected.

Simplified acute physiology score II and Mannheim peritonitis index are associated with in-hospital mortality in patients with abdominal sepsis admitted to ICU.

OBJECTIVE: The objective of this study was to assess the association and interaction of laboratory parameters, Simplified Acute Physiology Score II (SAPSII), Modified Shock Index (MSI), and Mannheim Peritonitis Index (MPI) with in-hospital mortality. MATERIAL AND METHODS: We conducted a single-center case-control study. Adult patients with abdominal sepsis were included from May 2015 to May 2020. Baseline characteristics, laboratory parameters, SAPSII, MSI, and MPI scores at admission were collected. A principal component (PC) analysis was applied to evaluate variable interactions. In-hospital mortality risk was determined through logistic regression models. RESULTS: One hundred and twenty-seven patients were identified, 60 of which were included for analyses. Non-survivors (48.4%) had a higher frequency of hypertension, lactate and MPI, and lower BE and alactic BE levels. Eight PCs were obtained, PC1 being a linear combination of pH, AG, cAG, alactic BE, bicarbonate, and BE. MPI (OR = 9.87, 95% CI: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, 95% CI: 1.01-1.14, p = 0.01), and PC1 (OR = 2.13, 95% CI: 1.12-4.76, p = 0.04) were significantly associated with mortality in univariate analysis, while MPI (OR = 10.1, 95% CI: 3.03-40.06, p = 0.0003) and SAPSII (OR = 1.07, CI95%: 1.01-1.14, p = 0.02) remained significant after adjusting for age and sex. CONCLUSION: MPI and SAPSII were associated with mortality, although the interaction of laboratory parameters was not.

OBJETIVO: Evaluar la asociación e interacción de los parámetros de laboratorio, SAPSII, MSI y MPI con la mortalidad intrahospitalaria. MATERIALES Y MÉTODOS: Nosotros realizamos un estudio de casos y controles de pacientes adultos con sepsis abdominal desde mayo 2015 a mayo 2020. Recolectamos las características basales, parámetros de laboratorio, SAPSII, MSI y MPI al ingreso. Se aplicó un Análisis de Componentes Principales. El riesgo de mortalidad intrahospitalaria se determinó mediante modelos de regresión logística. RESULTADOS: Identificamos 127 pacientes, 60 de los cuales se incluyeron. Los no supervivientes (48,4%) tuvieron mayor frecuencia de HAS, lactato y MPI, y menores niveles de EB y EB aláctico. Se obtuvieron ocho Componentes Principales (PC), siendo PC1 una combinación lineal de pH, AG, cAG, EB aláctico, bicarbonato y EB. MPI (OR = 9.87, IC95%: 3.07-36.61, p = 0.0002), SAPSII (OR = 1.07, IC95%: 1.01-1.14, p = 0.01) y PC1 (OR = 2.13, IC95%: 1.12-4.76, p = 0.04) se asociaron significativamente con la mortalidad en el análisis univariado, mientras que MPI (OR = 10.1, IC95%: 3.03-40.06, p = 0.0003) y SAPSII (OR = 1.07, IC 95%: 1.01-1.14, p = 0.02) permanecieron significativos después del ajuste por edad y sexo. CONCLUSIONES: MPI y SAPSII se asociaron con mortalidad, aunque la interacción de los parámetros de laboratorio no lo hizo.

Glycosylated hemoglobin as a predictor of mortality in severe pneumonia by COVID-19.

OBJECTIVE: Determine whether the levels of glycated hemoglobin (HbA1c) measured on admission to the intensive care unit (ICU) are associated with mortality in patients with severe SARS-CoV-2 pneumonia with invasive mechanical ventilation. DESIGN: Cohort study, retrospective, observational. A single center. PLACE: ICU of a second-level care hospital. PATIENTS: Severe SARS-CoV-2 pneumonia confirmed with IMV since admission to the ICU. INTERVENTIONS: none. RESULTS: A total of 56 patients with severe pneumonia, confirmed with SARS-CoV-2, all with IMV. The group with HbA1c <6.5% included 32 (57.14%) patients and the group with HbA1c ≥6.5% included 24 (42.86%) patients and the mortality rate in ICU was 43.8% and 70.8%, respectively, with p = 0.04. Predictors of mortality at 28 days in ICU were DHL >500 U/L, OR 3.65 (95% CI 1.18-11.29), HbA1c ≥6.5%, OR 3.12 (95% CI 1.01-9.6), SAH, OR 3.12 (95% CI 1.01-9.5), use of vasopressor, OR 0.2 (95% CI 0.05-0.73), diabetes was not statistically significant. CONCLUSION: The 28-day probability of survival in patients with severe SARS-CoV-2 pneumonia with IMV in the ICU is lower when the HbA1c level is ≥6.5% on admission.

Aiming for zero fluid accumulation: First, do no harm.

Critically ill patients are often presumed to be in a state of "constant dehydration" or in need of fluid, thereby justifying a continuous infusion with some form of intravenous (IV) fluid, despite their clinical data suggesting otherwise. Overzealous fluid administration and subsequent fluid accumulation and overload are associated with poorer outcomes. Fluids are drugs, and their use should be tailored to meet the patient's individualized needs; fluids should never be given as routine maintenance unless indicated. Before prescribing any fluids, the physician should consider the patient's characteristics and the nature of the illness, and assess the risks and benefits of fluid therapy. Decisions regarding fluid therapy present a daily challenge in many hospital departments: emergency rooms, regular wards, operating rooms, and intensive care units. Traditional fluid prescription is full of paradigms and unnecessary routines as well as malpractice in the form of choosing the wrong solutions for maintenance or not meeting daily requirements. Prescribing maintenance fluids for patients on oral intake will lead to fluid creep and fluid overload. Fluid overload, defined as a 10% increase in cumulative fluid balance from baseline weight, is an independent predictor for morbidity and mortality, and thus hospital cost. In the last decade, increasing evidence has emerged supporting a restrictive fluid approach. In this manuscript, we aim to provide a pragmatic description of novel concepts related to the use of IV fluids in critically ill patients, with emphasis on the different indications and common clinical scenarios. We also discuss active deresuscitation, or the timely cessation of fluid administration, with the intention of achieving a zero cumulative fluid balance.

Aplicaciones e implicaciones de la pausa al final de la inspiración en ventilación mecánica / Applications and implications of end-inspiratory pause in mechanical ventilation / Aplicações e implicações da pausa ao final da inspiração na ventilação mecânica

Resumen: El uso de la pausa al final de la inspiración (PFI) en ventilación mecánica data de hace más de 50 años y con mayor impulso en la década de los 70, se le atribuye una mejoría en la presión parcial de oxígeno arterial (PaO2) al incrementar la presión media de la vía aérea (Pma), mayor aclaramiento de la presión parcial de dióxido de carbono arterial (PaCO2) y permite la monitorización de la presión meseta (Pmeseta) en la mecánica ventilatoria; sin embargo, los estudios clínicos sobre su uso son escasos y controversiales. En este artículo se abordan los mecanismos fisiológicos, fisiopatológicos y la evidencia sobre el uso de la PFI en ventilación mecánica (VM).

Abstract: The use of the end inspiratory pause (EIP) in mechanical ventilation has been going on for more than 50 years and with greater momentum in the 1970s, an improvement in the partial pressure of arterial oxygen (PaO2) is attributed to the increase mean airway pressure, greater clearance of partial pressure of arterial carbon dioxide and allows monitoring of plateau pressure in ventilatory mechanics; However, the Clinical studies on its use are few and controversial. This article addresses the physiological and pathophysiological mechanisms and the evidence on the use of EIP in mechanical ventilation.

Resumo: A utilização da pausa ao final da inspiração (PFI) na ventilação mecânica remonta a mais de 50 anos e com maior impulso na década de 70, atribui-se uma melhora na pressão parcial de oxigênio arterial (PaO2) pelo aumento da pressão média das vias aéreas (Pma), uma maior depuração da pressão parcial de dióxido de carbono arterial (PaCO2) e permite a monitorização da pressão de platô (Pplateau) na mecânica ventilatória, porém estudos Os dados clínicos sobre seu uso são escassos e controversos. Este artigo aborda os mecanismos fisiológicos e fisiopatológicos e as evidências sobre o uso do PFI na ventilação mecânica (VM).

Movilización temprana en la Unidad de Cuidados Intensivos / Early mobilization in the Intensive Care Unit / Mobilização precoce na Unidade de Terapia Intensiva

Resumen: La movilización temprana (MT) es la implementación de ejercicio físico en los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) observándose beneficios importantes como reducción de neumonías asociadas con ventilación mecánica (NAVM), trombosis venosa profunda, úlceras por presión, debilidad adquirida en la UCI (DAUCI). Además, tiene un impacto financiero al reducir los días de estancia hospitalaria y en la UCI. Cabe mencionar que la MT impacta en el desenlace posterior al alta hospitalaria reduciendo la aparición de síndrome postcuidados intensivos (PICS).

Abstract: Early mobilization (EM) is the implementation of physical exercise in patients admitted to the Intensive Care Unit (ICU), with important benefits being observed such as reduction of ventilator-associated pneumonia, deep vein thrombosis, pressure ulcers and ICU-acquired weakness (ICU-AW). It also has a financial impact by reducing hospital length of stay and in the ICU. Also, EM has an important role in the outcome once the patient leaves the hospital reducing the post-intensive care syndrome (PICS).

Resumo: A mobilização precoce (MP) é a implementação de exercícios físicos em pacientes internados em Unidade de Terapia Intensiva (UTI), observando benefícios importantes como redução da pneumonia associada à ventilação mecânica (PAV), trombose venosa profunda, úlceras por pressão, fraqueza adquirida no UTI (DAUCI). Além disso, tem impacto financeiro ao reduzir os dias de internação e internação na UTI. Vale ressaltar que a MT tem impacto no desfecho após a alta hospitalar por reduzir o aparecimento da Síndrome de Terapia Pós-Intensiva (PICS).

Impacto de la presión de distensión alveolar en los pacientes con síndrome de distrés respiratorio agudo (SDRA): revisión narrativa / Impact of alveolar distention pressure on days under mechanical ventilation in patients with acute respiratory distress syndrome (SDRA) / Impacto da pressão da distensão alveolar em pacientes com síndrome do desconforto respiratório agudo (SDRA): revisão narrativa

Resumen: Introducción: El síndrome de distrés respiratorio agudo (SDRA) se caracteriza por una heterogeneidad del daño en el parénquima pulmonar; la asociación entre el volumen tidal (Vt) y la distensibilidad pulmonar estática (Cst) puede ser evaluada mediante la presión de distensión (PD). Se desconoce hasta el día de hoy si el control de la PD impacta en otros objetivos, tales como la disminución de los días bajo ventilación mecánica. Material y métodos: Se realizó una revisión de artículos médicos científicos en Pubmed, EMBASE y Medigraphic con las siguientes palabras clave: «driving pressure¼ y «acute respiratory distress syndrome¼ para relacionar la PD y los días libres de ventilación mecánica en los principales estudios sobre SDRA; se analizaron las variables respiratorias reportadas por estas publicaciones y se tomaron estudios de revisión, revisiones sistematizadas y metaanálisis, lo cual fue evaluado por seis de los autores principales. Resultados: Se encontró en la revisión sistematizada la siguiente relación: los pacientes ventilados con SDRA y PD < 15 cmH2O se asociaban con menos días de ventilación mecánica con un valor de p = 0.03; los pacientes ventilados con SDRA y PD < 15 cmH2O, al comparar la mortalidad a 90 días, la disminuían, tomando un valor de p ≤ 0.0001; los pacientes sin SDRA y PD < 15 cm cmH2O, comparando la mortalidad a 28 días con una p = 0.005, las complicaciones pulmonares postoperatorias, la PD < 15 cmH2O y los valores de PD mayores a 15 cmH2O se asociaron con barotrauma, infecciones pulmonares postoperatorias, con una p ≤ 0.0001; en supervivencia y mortalidad a los 90 días, se correlacionó con una razón de momios (RM) de 0.60 a favor de PD < 15 cmH2O, y en mortalidad a 28 días con una RM de 0.29 a favor de la PD menor, al valor de corte. Conclusión: La PD se asocia con mortalidad de manera directamente proporcional y los valores más bajos de PD se asocian con menos días de ventilación mecánica.

Abstract: Introduction: ARDS is characterized by a heterogeneity of damage in the lung parenchyma and the association between tidal volume (Vt) and static lung compliance (Cst) can be evaluated by DP. Most studies on DP and ARDS focus on mortality, showing a lower percentage of survival while the level of DP is higher, however, it is unknown until today whether the control of DP impacts on other objectives such as decrease of days under mechanical ventilation. Material and methods: A systematic review of medical articles in Pubmed, EMBASE and Medigraphic was carried out with key words: driving pressure and acute respiratory distress syndrome to relate DP and days free of mechanical ventilation in the main studies on ARDS, analyzing the respiratory variables reported by these publications. Results: The relationship was found in the systematized review; that patients ventilated with ARDS and DP < 15 cmH2O was associated with fewer days of mechanical ventilation with a p = 0.03, patients with ARDS and DP < 15 cmH2O comparing mortality at 90 days, decreased their mortality with p ≤ 0.0001, patients without ARDS and PD < 15 cm cmH2O comparing mortality at 28 days with p = 0.005, patients with ARDS and DP association of postoperative pulmonary complications and DP < 15 cmH2O, DP values greater than 15 cmH2O was associated with barotrauma, postoperative pulmonary infections, with a p ≤ 0.0001 of, in survival and mortality at 90 days, correlated with a odds ratio (OR) of 0.60 in favor of DP less than 15 cmH2O and in mortality at 28 days with an OR of 0.29, in favor of DP below 15 cmH2O. Discussion: DP is associated with mortality in a directly proportional way. Conclusion: Lower values of DP are associated with fewer days of mechanical ventilation.

Resumo: Introdução: A SDRA é caracterizada pela heterogeneidade do dano do parênquima pulmonar e a associação entre volume corrente (Vt) e complacência pulmonar estática (Cst) pode ser avaliada por pressão de distensão alveolar (PD). Não se sabe até hoje se o controle da PD afeta outros objetivos, como redução de dias sob ventilação mecânica. Material e métodos: Foi realizada uma revisão de artigos médicos científicos no Pubmed, EMBASE e Medigraphic com palavras-chave: pressão de distensão e síndrome do desconforto respiratório agudo para relacionar PD e dias sem ventilação mecânica nos principais estudos de SDRA, analisando as variáveis relatados por essas publicações, realizando estudos de revisão, revisões sistemáticas e meta-análises, sendo avaliados por 6 dos principais autores. Resultados: A relação foi encontrada na revisão sistemática; que ventilaram pacientes com SDRA e PD < 15 cmH2O estiveram associados a menos dias de ventilação mecânica com p = 0.03, pacientes ventilados com SDRA e PD < 15 cmH2O comparando a mortalidade em 90 dias, sua mortalidade diminuiu com p ≤ 0.0001, pacientes sem SDRA e PD < 15 cm cmH2O comparando mortalidade em 28 dias com p = 0.005, associação de complicações pulmonares pós-operatórias e PD < 15 cmH2O, valores de PD maiores que 15 cmH2O foram associados a traumatismo barro, infecções pulmonares pós-operatórias , com p ≤ 0.0001 de, na sobrevida e mortalidade aos 90 dias, foi correlacionada com uma Odds Ratio (RM) de 0.60 a favor da PD menor que 15 cmH2O e na mortalidade aos 28 dias com uma RM de 0.29, a favor do PD menor que o valor de corte. Conclusão: a PD está associada à mortalidade de maneira diretamente proporcional. e valores mais baixos de PD estão associados a menos dias de ventilação mecânica.

Protocolo de manejo para la infección por COVID-19 / Management protocol for COVID-19 / Protocolo de tratamento para a infecção por COVID-19

Resumen: El 31 de diciembre de 2019 se reportaron en Wuhan, China los primeros casos de neumonía de origen desconocido, más tarde identificado como nuevo Coronavirus (2019-nCoV o COVID-19), genéticamente distinto de otros coronavirus como SARS-CoV y MERS-CoV, oficialmente identificado como SARS-CoV-2. En marzo de 2020, la Organización Mundial de la Salud (OMS) declaró alerta de pandemia por esta enfermedad, que ha infectado a miles de personas como consecuencia de afección pulmonar por síndrome de distrés respiratorio agudo (SDRA), por lo que es prioridad conocer el abordaje de manejo para el COVID-19.

Abstract: On December 31, 2019, the first cases of pneumonia of unknown origin were reported in Wuhan, China, later identified as a new Coronavirus (2019-nCoV or COVID-19), genetically distinct from other coronaviruses such as SARS-CoV and MERS-CoV, officially identified as SARS-CoV-2. In March 2020, the World Health Organization (WHO) declared a pandemic alert for this disease, which has infected thousands of people, as a consequence of pulmonary affection due to acute respiratory distress syndrome (ARDS), making it a priority to know the management approach for COVID-19.

Resumo: Em 31 de dezembro de 2019, os primeiros casos de pneumonia de origem desconhecida foram relatados em Wuhan, China, posteriormente identificado como um novo Coronavírus (2019-nCoV ou COVID-19), geneticamente diferente de outros coronavírus, como SARS-CoV e MERS-CoV , oficialmente identificado como SARS-CoV-2. Em março de 2020, a Organização Mundial da Saúde (OMS) declarou um alerta de pandemia para esta doença, que infectou milhares de pessoas, como consequência de uma doença pulmonar devido à síndrome do desconforto respiratório agudo (SDRA), tornando-se uma prioridade conhecer a abordagem de gerenciamento do COVID-19.

Fluidoterapia intravenosa guiada por metas / Intravenous fluid therapy guided by goals

Resumen La fluidoterapia es la primera maniobra realizada por el médico al estar en contacto con un paciente al que se pretende incrementar la volemia, la administración del tipo de solución parenteral, la cantidad y la duración en su aplicación es el reto del intensivista. En la actualidad el monitoreo hemodinámico ha tenido un importante avance tecnológico, al ser mínimamente invasivo y con constantes no sólo estáticas sino dinámicas, lo que ha permitido mejorar la toma de decisiones médicas en el paciente críticamente enfermo. Esta revisión no sistemática tiene como objetivo proporcionar una actualización de las mediciones que son consideradas nuevas herramientas ante viejos paradigmas en el monitoreo hemodinámico.

Abstract Fluid therapy is the first maneuver performed by the physician to be in contact with a patient who is intended to increase the volemia, the administration of parenteral solution type, the amount and duration in its application is the challenge of the intensivist. Currently the hemodynamic monitoring has undergone an important technological advance, being minimally invasive and with not only static but also dynamic constants, they have allowed to improve the medical decision making in the critically ill patient. The present non-systematic review aims to provide an update on measurements that are considered new tools before old paradigms in hemodynamic monitoring.

Síndrome de dificultad respiratoria aguda severo en el embarazo. Revisión de la literatura y reporte de dos casos / Severe acute respiratory distress syndrome in pregnancy. Review of the literature and two cases report / Síndrome do disconforto respiratório agudo grave na gestação. Revisão de literatura e relato de dois casos

Resumen: La mujer durante el embarazo, parto y puerperio presenta cambios anatómicos, fisiológicos y en la dinámica ventilatoria, por lo que una de las complicaciones que puede presentar es el síndrome de dificultad respiratoria aguda, el cual representa un reto para el clínico, pudiendo aparecer complicaciones en el embarazo como corioamnionitis, aborto, embolismo de líquido amniótico. El abordaje y tratamiento del síndrome de dificultad respiratoria aguda es primordial, se han presentado avances en la estrategia ventilatoria como: disminución del volumen tidal y posición prono durante la ventilación mecánica, que han mejorado el pronóstico de manera favorable en esta población.

Abstract: The woman during pregnancy, delivery and puerperium presents anatomical changes, physiological and ventilatory dynamics, so one of the complications that may present is the acute respiratory distress syndrome (ARDS) representing a challenge for the clinician, and complications may appear in pregnancy as chorioamnionitis, abortion, amniotic fluid embolism. The approach and treatment of ARDS in the patient is paramount. Advances have been made in the ventilatory strategy, such as: decreased tidal volume, prone position during mechanical ventilation, which have improved the prognosis favorably in this population.

Resumo: A mulher durante a gestação, parto e puerpério apresenta alterações anatômicas, fisiológicas e ventilatórias, por isso uma das complicações que ela pode apresentar é a Síndrome do Desconforto Respiratório Agudo (SDRA), representando um desafio para o clínico, podendo aparecer complicações na gestação, como corioamnionitis, aborto, embolia do líquido amniótico. A abordagem e tratamento da SDRA no paciente é essencial, houve avanços na estratégia ventilatória como: diminuição do volume corrente, posição prona durante a ventilação mecânica, que melhoraram o prognóstico favoravelmente nessa população.