Mechanical Ventilation and ARDS in Critical Care Obstetrics

The FlightBridgeED Podcast

Mechanical Ventilation and ARDS – Podcast Summary and References

This is the sixth of a special podcast series on obstetric critical care. I am joined on this series by Dr. Elizabeth Garchar, MD, FACOG. She is an OB/GYN and Maternal Fetal Medicine (MFM) specialist who has a particular interest in obstetric critical care. She is also unique in that she flies regularly with our critical care transport teams as a retrieval OBGYN/MFM and is one of our Assistant Medical Directors for the flight program.

The topic of this podcast is Mechanical Ventilation and ARDS in pregnancy. Although respiratory distress requiring intubation and ARDS in pregnancy is not very common, it is more common than some of the other pathologies we have discussed recently. Mechanical ventilation of the pregnant patient can be intimidating, but rest assured that if you have the capabilities to manage other patients on a vent, you can manage the pregnant patient. Generally speaking solid outcomes data is sparse and, generally speaking, most guidelines recommend vent management of mechanical ventilation in patients with or without ARDS similarly to non-pregnant patients…with a few exceptions. This podcast reviews the basics of ARDS and evidence-based management. It reviews some specific features of obstetric physiology and fetal gas exchange that are important to keep in mind. Finally, we will review what guidance is available and review general recommendations for managing these patients in transport.

For additional learning and a more in-depth review of the evidence check out this talk on gas exchange and mechanical ventilation in critically ill patients by Dr. Allison Lankford (part of the amazing Maryland CC Project lecture series): http://maryland.ccproject.com/2023/05/30/lankford-gas-exchange-and-pulmonary-ventilation-in-the-critically-ill-obstetric-patient/

References

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