Considerations on airway and ventilatory disorders in critical care obstetric patients

A.D. Stanescu, R.S. Sima, D.O. Balalau, L. Ples

Rezumat: Introduction. The respiratory tract undergoes important changes as a result of the maternal adap tation to pregnancy. Histological findings on res pi ratory tissues, anatomical relationships, and res pi ra tory function are altered by the gravid uterus and the hormonal and metabolic changes of advanced ges tation. Assessing a pregnant woman for respiratory il lness involves understanding these changes and in ter preting laboratory data in the proper context. Materials and methods. We reviewed the recent international database and meta-analyses about diagnosis consideration and management in pregnancies with acute respiratory distress. Results. The management of the obstetric patient with acute respiratory distress can present unique critical care challenges. The etiology of acute respiratory distress in parturients is multiple and the diagnosis must be clinically and laboratory guided. Normal physiologic changes of pregnancy may obscure the presentation and diagnosis, and irrelevant of the cause, pregnancy may complicate the management of hypoxic and hypercarbic respiratory failure in this patient population. Furthermore, both anticipated and unanticipated difficult airway management, including difficulty ventilating and intubating, are more frequent during pregnancy and may be encountered during endotracheal tube placement. Conclusions. The diagnosis of obstetric patient with acute respiratory distress is guided by physiological changes in pregnancy and it can raise critical care challenges.
Cuvinte cheie: respiratory distress, ventilation, critical care.