Critical Matters Critical Care In Pregnancy (Part 2) V1
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Jun 12, 2019 Dr. Stephen Lapinsky, a practicing intensivist and professor at the University of Toronto, delves into the unique critical care challenges faced by pregnant patients. He discusses the increased thromboembolic risks due to pregnancy-related coagulation changes and outlines diagnostic methods for conditions like DVT and PE. Lapinsky highlights the importance of tailored treatments, such as low-molecular-weight heparin, and emphasizes crucial airway management strategies. He also tackles the complexities of cardiac arrest management, providing insights on resuscitation techniques and the benefits of timely perimortem cesarean sections.
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Apply Lung-Protective Ventilation; Allow Mild Hypercapnia
- For ventilated pregnant patients follow standard ARDS lung-protective strategies (≈6 mL/kg) and accept mild hypercapnia when needed.
- Expect reduced respiratory compliance and slightly higher plateau pressures due to the elevated diaphragm and gravid uterus.
Rescue Therapies Can Be Used Safely
- Several rescue therapies (neuromuscular blockade, prone positioning, inhaled NO, ECMO) have been used successfully in pregnancy.
- Prone positioning may improve uterine and placental blood flow and ECMO has yielded good mother–fetus outcomes in H1N1 cases.
Maternal Circulation Prioritizes Mother Over Fetus
- Maternal physiology prioritizes heart and brain perfusion, not the fetus, so maternal hypotension reduces uterine blood flow early.
- Treat the mother aggressively because maternal survival gives the best chance for fetal survival.