Noninvasive Ventilation in a Pregnant Patient With Respiratory Failure From All-Trans-Retinoic-Acid (ATRA) Syndrome

Bassani, Mariana Almada; Oliveira, Ana Beatriz Francioso de; Neto, Antônio F. Oliveira

doi:10.4187/002013209793800466

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…A minority of hematology-oncology patients experience respiratory failure from pulmonary emboli, alveolar hemorrhage, and cardiogenic pulmonary edema [49,50]. NIV has been employed successfully in cases of lung injury related to chemotherapy agents, notably gefitinib [51], alltransretinoic acid (ATRA) [52,53], and the combination of docetaxel and gemcitabine [54]. People with lung cancer commonly have exacerbations of congestive heart failure (CHF) and COPD as secondary precipitants of respiratory distress [55].…”

Section: Noninvasive Ventilation In Advanced Cancermentioning

confidence: 99%

Noninvasive ventilation as a palliative measure

Gifford

2014

Current Opinion in Supportive &Amp; Palliative Care

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NIV is an important adjunct to medications for patients with intractable dyspnea. Future research should attempt to clarify the effectiveness of NIV at controlling dyspnea within and outside the hospital. Barriers to its domiciliary application are largely unknown. Processes should be developed to optimize communication among clinicians, patients, and their caregivers around the issues of when to start NIV and how to withdraw it at the end of life.

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Section: Noninvasive Ventilation In Advanced Cancermentioning

confidence: 99%

Noninvasive ventilation as a palliative measure

Gifford

2014

Current Opinion in Supportive &Amp; Palliative Care

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“…[1063646566] It avoids the potential complications of endotracheal intubation, and that of the drugs used for sedation. Usually, an inspiratory pressure of 12–15 cmH 2 O and an expiratory pressure of 5–8 cmH 2 O are used.…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature

Bhatia

Biyani

Mohammed

et al. 2016

J Anaesthesiol Clin Pharmacol

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Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.

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“…Several case reports and small series have shown favourable outcomes with NIV use for respiratory failure in pregnancy (table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

“…Surprisingly, several accounts of successful applications of NIV in pregnancy have also been described in ARDS. Cases of ARDS associated with all-trans-retinoic acid syndrome, community-acquired pneumonia, sepsis and, more recently, influenza A (H1N1) virus have been published previously [9][10][11]. AL-ANSARI et al [12] described four pregnant patients with sickle cell disease who presented with acute chest syndrome and ARDS.…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

“…Patient selection is paramount and indications and contraindications to its use must be considered carefully. To optimise the safety of NIV in this setting, staff should be [15] 2006 Case report 1 Non-cardiogenic pulmonary oedema AL-ANSARI [12] 2007 Case series 4 ARDS, acute chest syndrome PERBET [6] 2008 Case report 1 Non-cardiogenic pulmonary oedema associated with tocolytic agents BANGA [9] 2009 Case report 1 ARDS, community-acquired pneumonia BASSANI [10] 2009 Case report 1 ARDS/ATRA syndrome YUAN [5] 2009 Case report 1 Ventilatory failure, neuromuscular (mitochondrial myopathy) GUTERRES [14] 2010 Case report 1 Ventilatory failure, neuromuscular (high neuraxial blockade) DJIBRÉ [11] 2010 Case report 1 ARDS, H1N1 ERDOGAN [13] 2010 Case report 1 Non-cardiogenic pulmonary oedema, severe preeclampsia FRASSANITO [17] 2011 Case report 1 ARDS, sepsis ROJAS-SUAREZ [7] 2011 Case report 1 Non-cardiogenic pulmonary oedema, severe preeclampsia DUAN [8] 2012 Case report 1 Aspiration pneumonia DALAR [18] 2013 Case report 1 Community-acquired pneumonia DRAISCI [19] experienced in its use and patients should be in a protected environment, such as an ICU, in order to monitor changes in the clinical state of the mother and fetus.…”

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

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Successful use of noninvasive ventilation in pregnancy

Allred¹,

Esquinas²,

Caronia³

et al. 2014

Eur Respir Rev

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Acute respiratory failure (ARF) occurs in less than 0.1% of pregnancies; however, it is one of the most common reasons for obstetric admissions to the intensive care unit (ICU) and carries a high mortality for both mother and fetus. Pulmonary physiological and anatomic adaptations during pregnancy affect the overall management, as well as predispose patients to complications during respiratory illness. Pregnancyrelated upper airway mucosal oedema may obstruct visualisation of the airway during intubation and can make invasive airway management difficult. The pregnant female requiring endotracheal intubation has a four-fold higher risk of having a difficult airway and an eight-fold higher risk of a failed intubation [1].The application of noninvasive ventilation (NIV) in the treatment of ARF continues to expand as its benefits are increasingly recognised. NIV is often avoided in pregnancy due to the theoretical risk of aspiration. However, our current knowledge regarding the safety and efficacy of NIV for the management of respiratory failure in pregnancy is based on weak evidence. Only a few case reports and small case series have been published. Given the limited data, we review the current literature and report two cases of pregnant females who developed ARF from acute respiratory distress syndrome (ARDS) and were successfully and safely managed with NIV. Case 1A 30-year-old gravida 2 para 1 with an uncomplicated twin pregnancy presented with premature rupture of membranes at 30 weeks of gestation. She had also complained of a dry cough for 1 week prior to presentation and a low grade fever. Corticosteroids, antibiotics and tocolytic therapy were administered. On day 2 of admission, she developed acute shortness of breath and complained of severe chest pressure and worsening cough. Her oxygen saturation was 87% while breathing room air. On physical examination, she appeared to be in moderate respiratory distress, was alert and awake, and had reduced breath sounds bilaterally. Rhonchi were auscultated over her right lung field and she was subsequently transferred to the medical ICU.Arterial blood gas (ABG) results on 100% oxygen via a non-rebreather mask showed an oxygen tension (PO 2 ) of 58 mmHg, pH of 7.49 and a carbon dioxide tension (PCO 2 ) of 27 mmHg. Her breathing became more laboured and the decision was made to place her on NIV with an inspiratory pressure of 12 cmH 2 O and an expiratory pressure of 5 cmH 2 O. Inspiratory oxygen fraction (FIO 2 ) was set to 100%. Fetal monitoring was initiated. Her work of breathing and oxygenation rapidly improved. Repeat ABG analysis 1 h later revealed a PO 2 of 152 mmHg on the same settings. Clindamycin was added for suspected aspiration pneumonia. Computed tomography of the chest showed diffuse, bilateral airspace disease. An echocardiogram was unremarkable. Over the next 2 days she was weaned off NIV and her clinical condition continued to improve. She tolerated the mask well and no episodes of aspiration or other complications occurred. However, her contractions...

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Noninvasive Ventilation in a Pregnant Patient With Respiratory Failure From All-Trans-Retinoic-Acid (ATRA) Syndrome

Cited by 8 publications

References 21 publications

Noninvasive ventilation as a palliative measure

Noninvasive ventilation as a palliative measure

Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature

Successful use of noninvasive ventilation in pregnancy

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