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Abstract
The purpose of this review is to describe updates following initial recommendations on best anesthesia practices for obstetric patients with coronavirus disease 2019. The first surge in the United States prompted anesthesiologists to adapt workflows and reconsider obstetric anesthesia care, with emphasis on avoidance of general anesthesia, the benefit of early neuraxial labor analgesia, and prevention of emergent cesarean delivery whenever possible. While workflows have changed to allow sustained safety for obstetric patients and health care workers, it is notable that obstetric anesthesia protocols for labor and delivery have not significantly evolved since the first coronavirus disease 2019 wave.
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Faverio P, Ornaghi S, Stainer A, Invernizzi F, Borelli M, Brunetti F, La Milia L, Paolini V, Rona R, Foti G, Luppi F, Vergani P, Pesci A. Feasibility of CPAP application and variables related to worsening of respiratory failure in pregnant women with SARS-CoV-2 pneumonia: Experience of a tertiary care centre. PLoS One 2021; 16:e0258754. [PMID: 34665818 PMCID: PMC8525751 DOI: 10.1371/journal.pone.0258754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
Continuous positive airway pressure (CPAP) has been successfully applied to patients with COVID-19 to prevent endotracheal intubation. However, experience of CPAP application in pregnant women with acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia is scarce. This study aimed to describe the natural history and outcome of ARF in a cohort of pregnant women with SARS-CoV-2 pneumonia, focusing on the feasibility of helmet CPAP (h-CPAP) application and the variables related to ARF worsening. A retrospective, observational study enrolling 41 consecutive pregnant women hospitalised for SARS-CoV-2 pneumonia in a tertiary care center between March 2020 and March 2021. h-CPAP was applied if arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) was inferior to 200 and/or patients had respiratory distress despite adequate oxygen supplementation. Characteristics of patients requiring h-CPAP vs those in room air or oxygen only were compared. Twenty-seven (66%) patients showed hypoxemic ARF requiring oxygen supplementation and h-CPAP was needed in 10 cases (24%). PaO2/FiO2 was significantly improved during h-CPAP application. The device was well-tolerated in all cases with no adverse events. Higher serum C reactive protein and more extensive (≥3 lobes) involvement at chest X-ray upon admission were observed in the h-CPAP group. Assessment of temporal distribution of cases showed a substantially increased rate of CPAP requirement during the third pandemic wave (January-March 2021). In conclusion, h-CPAP was feasible, safe, well-tolerated and improved oxygenation in pregnant women with moderate-to-severe ARF due to SARS-CoV-2 pneumonia. Moderate-to-severe ARF was more frequently observed during the third pandemic wave.
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Affiliation(s)
- Paola Faverio
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- * E-mail:
| | - Sara Ornaghi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Anna Stainer
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Francesca Invernizzi
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Mara Borelli
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Federica Brunetti
- Department of Obstetrics and Gynaecology, Desio Hospital, ASST Monza, Desio, Italy
| | - Laura La Milia
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Valentina Paolini
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Roberto Rona
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Giuseppe Foti
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy
| | - Fabrizio Luppi
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Patrizia Vergani
- Obstetric Unit, School of Medicine and Surgery, University of Milano Bicocca, MBBM Foundation Onlus at San Gerardo Hospital, Monza, Italy
| | - Alberto Pesci
- Respiratory Unit, School of Medicine and Surgery, University of Milano Bicocca, San Gerardo Hospital, ASST Monza, Monza, Italy
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