Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome.
Gilmar de Souza OsmundoCristiane de Freitas PaganottiRafaela Alkmin da CostaThiago Henrique Dos Santos SilvaPaula Carolina BombonatiLuiz Marcelo Sa MalbouissonRossana Pulcinelli Vieira FranciscoPublished in: Vaccines (2022)
Prone positioning (PP) improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Data regarding feasibility and effectiveness of PP in pregnancy are lacking. This subgroup analysis of a cohort study that included mechanically ventilated pregnant women presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who underwent PP aims to assess the efficacy and safety of PP. Ventilatory and gasometric parameters were evaluated at baseline (T0) and in prone (T1) and supine (T2) positions. Obstetric outcomes were also assessed. Sixteen cases at an average of 27.0 (22.0−31.1) gestational weeks of pregnancy were included. Obesity and hypertension were frequent comorbidities. PP was associated with a >20% increase in PaO2 levels and in PaO2/FiO2 ratios in 50% and 100% of cases, respectively. The PaO2/FiO2 ratio increased 76.7% (20.5−292.4%) at T1 and 76.9% (0−182.7%) at T2. PP produced sustained improvements in mean PaO2/FiO2 ratio (p < 0.001) and PaCO2 level (p = 0.028). There were no cases of emergency delivery or suspected fetal distress in pregnancies ≥25 weeks during the 24 h period following PP. PP is safe and feasible during pregnancy, improving PaO2/FiO2 ratios and helping to delay preterm delivery in severe ARDS.
Keyphrases
- acute respiratory distress syndrome
- pregnant women
- extracorporeal membrane oxygenation
- mechanical ventilation
- sars cov
- respiratory syndrome coronavirus
- pregnancy outcomes
- preterm birth
- gestational age
- blood pressure
- early onset
- weight gain
- healthcare
- systematic review
- randomized controlled trial
- intensive care unit
- type diabetes
- emergency department
- metabolic syndrome
- coronavirus disease
- clinical trial
- low birth weight
- weight loss
- drug induced
- study protocol
- endothelial cells
- diabetic rats
- oxidative stress
- stress induced
- phase iii
- deep learning
- blood flow