Use of Extracorporeal Respiratory Support During Pregnancy

Grasselli, Giacomo; Bombino, Michela; Patroniti, Nicolò; Giuffrida, Alessandro; Marcolin, R; Vergani, Patrizia; Pesenti, Antonio

doi:10.1097/mat.0b013e318249695d

Cited by 23 publications

(10 citation statements)

References 17 publications

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“…The arterio-venous bypass, used in life threatening cardiac failure like a cardiac shock or decompensated cardiac myopathy, provides simultaneously pulmonary support. ECMO can also be inserted in a veno-venous access supporting oxygenation for pulmonary failure like severe cases of pneumonia, ARDS or for bridge to lung transplantation [15,16]. As a temporary respiratory support ECMO stabilizes gas exchanges while reducing lung injuries induced by mechanical ventilation [2,5,6].…”

Section: Discussionmentioning

confidence: 99%

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The use of life-saving extracorporeal membrane oxygenation (ECMO) for pregnant woman with status asthmaticus

et al. 2016

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This is the first case report on the successful use of ECMO in a pregnant woman with severe respiratory insufficiency due to status asthmaticus, who failed to respond to invasive mechanical ventilation and maximum pharmacological treatment. Despite this life-threatening condition, the use of ECMO in our patient has greatly improved the chance of survival for the mother and the baby, who was born without any complications.

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Section: Discussionmentioning

confidence: 99%

“…The use of ECMO during pregnancy has been relatively limited [15,16]. To the best of our knowledge, this is the first report of a successful use of ECMO in a pregnant woman with status asthmaticus.…”

Section: Introductionmentioning

confidence: 87%

The use of life-saving extracorporeal membrane oxygenation (ECMO) for pregnant woman with status asthmaticus

et al. 2016

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“…Reduced lower esophageal sphincter pressure may increase the risk of gastric acid reflux and aspiration, especially in the supine position. Although prone positioning has been used in respiratory failure in pregnancy, 20,21 the presence of the gravid uterus makes this position especially challenging.…”

Section: Patient Positioningmentioning

confidence: 99%

General Care of the Pregnant Patient in the Intensive Care Unit

Crozier

2017

Semin Respir Crit Care Med

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Pregnant women represent a small subset of all intensive care unit (ICU) admissions and may require intensive care for "obstetric" or "nonobstetric" reasons. Women may be admitted to the ICU at any stage of pregnancy or in the postpartum period. Pregnancy may be discovered at the time of admission to the ICU. Pregnancy impacts on ICU care in a variety of ways and requires a multidisciplinary approach to management. Pregnancy is associated with considerable physiological changes that affect most organ systems, including an expansion in blood volume, an increase in minute ventilation, and an increased risk of thrombosis. The enlarging uterus may be associated with mechanical complications due to compression and displacement of other structures. The growing fetus places considerable demands upon the mother, being reliant on maternal systems for oxygenation, nutrition and disposal of carbon dioxide, and other waste products. This "second patient" must be considered when managing the pregnant woman. Optimal management of the mother usually constitutes best treatment for the fetus. Maternal shock and physiological disturbance, medications, and ionizing radiation from diagnostic imaging may have harmful effects on the unborn child. Delivery of the fetus for either maternal or fetal indications may be necessary and should be planned for, even if considered unlikely to be required. Care of the postpartum woman has its own challenges, including managing lactation and facilitating mother/infant contact. In this article, the general care aspects of ICU treatment of the pregnant woman will be discussed, including monitoring, physiological target setting, and general supportive care.

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“…The use of ECMO has also been described during other elective thoracic surgical procedures and for support in the ICU after pulmonary endarterectomy as well as in emergency situations: a completely obstructed airway where tracheostomy was not possible ; massive aspiration ; lung trauma and pulmonary resection ; massive pulmonary embolus ; and status asthmaticus . Other uses have included severe burns and smoke inhalation , drug overdose and respiratory failure during pregnancy . The use of ECMO to facilitate surgery and for postoperative use is not covered by either of the two published guidelines referred to previously, and remains controversial, but such published successes are likely to lead to more widespread use in similar settings, especially in acutely ill patients.…”

mentioning

confidence: 99%