Dr Stephen Lapinsky
Mount Sinai Hospital, Toronto
Management of the critically ill pregnant patient is complicated by the altered respiratory and cardiac physiology induced by pregnancy, by perceived limitations in the use of drug therapy and imaging modalities, and by unusual pregnancy-specific conditions.
This presentation will review the pulmonary and cardiac physiological changes in pregnancy, as well as the physiology of fetal gas exchange. Aiming for high oxygen saturation levels is usually not appropriate, and moderate hypercapnia may be well tolerated. Imaging with ionizing radiation can be safely performed in pregnancy with appropriate precautions, but there is also a diagnostic role of POCUS in the critically ill pregnant patient. Life-threatening, pregnancy-related non-cardiac cardiovascular conditions will be reviewed, including amniotic fluid embolism, thromboembolism, preeclampsia and vascular rupture. Drug therapy in the critically ill pregnant patient, including inotropes, antibiotics and sedatives/analgesics are usually no different to the non-pregnant patient, with limited exceptions. Differences in the application of organ support interventions will be reviewed, including dialysis, mechanical ventilation and ECLS. Obstetric delivery usually provides little maternal benefit in the patient with respiratory failure.