Acute respiratory failure in pregnancy.

Area of Science:

• Obstetrics
• Critical Care Medicine
• Pulmonology

Background:

• Respiratory failure complicates up to 0.2% of pregnancies, often postpartum.
• Pregnancy alters respiratory physiology, impacting patient assessment and management.
• Conditions like preeclampsia, amniotic fluid embolism, and peripartum cardiomyopathy can cause respiratory failure.

Purpose of the Study:

• To review the unique challenges and management strategies for respiratory failure during pregnancy.
• To highlight pregnancy-specific risk factors and their impact on respiratory status.
• To provide guidance on respiratory support, including mechanical ventilation, in pregnant patients.

Main Methods:

• Literature review of respiratory failure in pregnancy.
• Analysis of physiological changes affecting respiratory function in pregnant individuals.
• Discussion of management protocols for intubation and mechanical ventilation.

Main Results:

• Endotracheal intubation in pregnancy poses higher risks due to airway edema and rapid desaturation.
• Limited data exist for prolonged mechanical ventilation, though reduced chest wall compliance may allow higher pressures.
• Permissive hypercapnia data is scarce, and fetal benefit is a key factor in considering delivery.

Conclusions:

• Management principles for respiratory failure in pregnancy are largely similar to non-pregnant patients.
• Specific adaptations are necessary for airway management and mechanical ventilation.
• Delivery should be considered primarily for fetal benefit, not always for maternal respiratory improvement.