Two Full-Term Pregnancies in a Patient with Mitochondrial Myopathy and Chronic Ventilatory Insufficiency

Díaz-Lobato, Salvador; Mendieta, Maria A Gómez; García, María Suárez; Mayoralas-Alises, Sagrario; Gutiérrez, Francisco Javier Arpa

doi:10.1159/000089584

Cited by 12 publications

(17 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This case required NIPPV only at night and progressively for only up to 20 h during pregnancy. 4 In contrast, our subject normally required NIPPV 20-22 h out of 24 h before her pregnancy, and required 24 h NIPPV support during the majority of her pregnancy and delivery. Four weeks after delivery, VS was seen back in the Pediatric Pulmonary Clinic.…”

Section: Discussionmentioning

confidence: 86%

“…1 Since 1990, isolated case reports of pregnancy and pregnancyrelated complications of various types of mitochondrial myopathy have been reported. [2][3][4][5][6][7][8] Respiratory insufficiency and depressed ventilatory drive is a known complication of mitochondrial myopathy and NIPPV may be helpful. 2 Noninvasive ventilation (NIV) refers to the provision of mechanical ventilation without the need for an invasive artificial airway or tracheostomy tube.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful pregnancy and cesarean delivery via noninvasive ventilation in mitochondrial myopathy

et al. 2009

View full text Add to dashboard Cite

We report a case study of a 22-year-old woman with mitochondrial thymidine kinase 2 deficiency and chronic respiratory failure due to severe neuromuscular weakness requiring noninvasive positive pressure ventilation (NIPPV) since 12 years of age. During pregnancy and cesarean delivery, she was successfully supported with NIPPV. A multidisciplinary team approach should be used in pregnant patients with these disorders with specific attention to management of pulmonary complications, selection of route of delivery, anesthesia, and analgesia.

show abstract

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Successful pregnancy and cesarean delivery via noninvasive ventilation in mitochondrial myopathy

et al. 2009

View full text Add to dashboard Cite

show abstract

“…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%

Section: Previous Case Reports Of Niv Use In Pregnancymentioning

confidence: 99%

“…With the assistance of NIV, all four females delivered healthy, full-term babies [2]. Further descriptions of NIV use in neuromuscular disease include two cases of successful pregnancies in females with chronic ventilatory insufficiency due to mitochondrial myopathy [4,5].NIV in pregnancy for indications other than ventilatory failure have also been described. Several studies demonstrating favourable outcomes with NIV use in parturients with hypoxaemic respiratory failure have been performed.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Successful use of noninvasive ventilation in pregnancy

Allred¹,

Esquinas²,

Caronia³

et al. 2014

Eur Respir Rev

View full text Add to dashboard Cite

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...

show abstract

Neuromuscular and Chest Wall Diseases in Pregnancy

Bach

Sancho

2009

Pulmonary Problems in Pregnancy

View full text Add to dashboard Cite

Two Full-Term Pregnancies in a Patient with Mitochondrial Myopathy and Chronic Ventilatory Insufficiency

Cited by 12 publications

References 25 publications

Successful pregnancy and cesarean delivery via noninvasive ventilation in mitochondrial myopathy

Successful pregnancy and cesarean delivery via noninvasive ventilation in mitochondrial myopathy

Successful use of noninvasive ventilation in pregnancy

Neuromuscular and Chest Wall Diseases in Pregnancy

Contact Info

Product

Resources

About