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- Title
Management and outcomes of pregnant women admitted to intensive care unit for severe pneumonia related to SARS-CoV-2 infection: the multicenter and international COVIDPREG study.
- Authors
Péju, Edwige; Belicard, Félicie; Silva, Stein; Hraiech, Sami; Painvin, Benoît; Kamel, Toufik; Thille, Arnaud W.; Goury, Antoine; Grimaldi, David; Jung, Boris; Piagnerelli, Michael; Winiszewski, Hadrien; Jourdain, Merce; Jozwiak, Mathieu; the COVIDPREG Study Group; Argaud, Laurent; Aubron, Cécile; Bèle, Nicolas; Beloncle, François; Bertrand, Pierre-Marie
- Abstract
<bold>Purpose: </bold>Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated.<bold>Methods: </bold>A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported.<bold>Results: </bold>Among the 187 pregnant women with COVID-19 (33 ± 6 years old and 28 ± 7 weeks' gestation), 76 (41%) were obese, 12 (6%) had diabetes mellitus and 66 (35%) had pregnancy-related complications. Standard oxygenation, high-flow nasal oxygen therapy (HFNO) and non-invasive ventilation (NIV) were used as the only oxygenation technique in 41 (22%), 55 (29%) and 18 (10%) patients, respectively, and 73 (39%) were intubated. Overall, 72 (39%) patients required several oxygenation techniques and 15 (8%) required venovenous extracorporeal membrane oxygenation. Corticosteroids and tocilizumab were administered in 157 (84%) and 25 (13%) patients, respectively. Awake prone positioning or prone positioning was performed in 49 (26%) patients. In multivariate analysis, risk factors for intubation were obesity (cause-specific hazard ratio (CSH) 2.00, 95% CI (1.05-3.80), p = 0.03), term of pregnancy (CSH 1.07, 95% CI (1.02-1.10), per + 1 week gestation, p = 0.01), extent of computed tomography (CT) scan abnormalities > 50% (CSH 2.69, 95% CI (1.30-5.60), p < 0.01) and NIV use (CSH 2.06, 95% CI (1.09-3.90), p = 0.03). Delivery was required during ICU stay in 70 (37%) patients, mainly due to maternal respiratory worsening, and improved the driving pressure and oxygenation. Maternal and fetal/neonatal mortality rates were 1% and 4%, respectively. The rate of maternal and/or neonatal complications increased with the invasiveness of maternal respiratory support.<bold>Conclusion: </bold>In ICU, corticosteroids, tocilizumab and prone positioning were used in few pregnant women with COVID-19. Over a third of patients were intubated and delivery improved the driving pressure.
- Subjects
BELGIUM; SWITZERLAND; INTENSIVE care units; PREGNANT women; PREGNANCY complications; PATIENT positioning; COVID-19
- Publication
Intensive Care Medicine, 2022, Vol 48, Issue 9, p1185
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-022-06833-8