Purpose Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated. Methods A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported. Results Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks’ gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05–3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02–1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30–5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09–3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support. Conclusion In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06833-8.

Excess soluble fms-like tyrosine kinase 1 (sFlt-1), a soluble inhibitor of the vascular endothelial growth factor pathway, has been demonstrated to promote endothelial dysfunction. Here we demonstrate that sFlt-1 plasma levels correlate with respiratory symptoms severity, expression of endothelial dysfunction biomarker and incidence of organ failure in COVID-19 patients.

During the coronavirus disease 2019 (COVID-19) pandemic, oxygen support management for critically ill patients with acute hypoxemic respiratory failure (AHRF) was a key component of clinical decisionmaking. 1 There is a lack of knowledge regarding the use of high-flow nasal cannula (HFNC) in COVID-19 patients with AHRF. Most hospitals adopted an early-intubation strategy leading to a high intubation rate and the demand for intensive care unit (ICU)-beds overwhelmed hospital resources. With a low ICU bed-to-population ratio in our area, we adopted a large high-flow nasal cannula (HFNC) therapy use in COVID-19 patient-related AHRF. Here, we assessed, retrospectively, the benefit of HFNC use in this population. | METHODSForty-two COVID-19-confirmed patients with AHRF treated with at least 2 hours of HFNC in first line were included in the study between March 1 and May 23, 2020 (Figure 1). The study was declared at European General Data Protection Regulation (Identifier RMR004-25052020). Inclusion criteria were laboratory-confirmed COVID-19 patients over 18 years of age suffering from AHRF treated with HFNC as first-line therapy and admitted to the medical ICU of the Reims University Hospital. Exclusion criteria were under 18 years of age, urgent need to intubate (less than 2 hours after HFNC initiation), previous intubation in the same hospital stay, and presence of a do-not-resuscitate order.HFNC was initiated with a minimum flow of 50 L/min with a FiO 2 of 50%. Then, FiO 2 was titrated targeting an SpO 2 above 92%, and flow rate was adjusted up to 60 L/min or according to the maximum tolerated dose. HFNC failure was defined as the subsequent need for invasive mechanical ventilation. Intubation criteria were left at the discretion of physicians. Respiratory parameters were measured under HFNC conditions. The ROX index was defined as the ratio of SpO 2 /FiO 2 (%) to respiratory rate (breaths/min). In patients with AHRF treated with HFNC, a ROX index higher than 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk of intubation. 2,3 Quantitative parameters were analyzed with nonparametric tests.Differences in categorical variables were assessed with chi-square. All tests were two-sided with a 5% significance level. | RESULTSResults are displayed in Table 1. Twenty-two patients were treated successfully with HFNC (52%) and twenty patients subsequently required IMV support (48%).At ICU admission, patients had a median PaO 2 /FiO 2 ratio of 128 for HFNC success group and 121.5 [88.5-135.5] for

ECD seems an interesting, safe, accurate, semi-invasive cooling method in OHCA patients treated with 33°C-TTM, particularly during the maintenance phase.