Use of noninvasive positive pressure ventilation during pregnancy: case series

Mechanical ventilation is commonly required in critically ill pregnant patients, requiring ICU admission, with higher morbidity and mortality related to airway management. Alternatively, noninvasive positive pressure ventilation [NIPPV] is increasingly used to treat nonpregnant patients. Pregnancy has been a contraindication to its use. We would like to report a case series of successful use of NIPPV in pregnancy. NIPPV is increasingly used to treat hypoxemic respiratory failure. It has rarely been used during pregnancy. On the other hand, acute respiratory failure [ARF] remains a leading cause of ICU admission in obstetric patients. The use of NIPPV in managing ARF in pregnant patients was not investigated. We report the outcome of treatment with NIPPV of four sickle cell disease pregnant patients with ARF caused by acute chest syndrome. Median APACHE II score for the four cases was 27. Intubation was avoided in all cases. None had aspiration. Mean duration of NIPPV was 40 h with ICU discharge after a mean of 4 days

Role of pulmonary artery catheterization in diagnosing types of shock

We report this case to demonstrate the role of pulmonary Artery Catheters [Swam Ganz catheters] in guiding the management of acutely ill patients in a state of shock. The patient is a 79-years old Bahraini male with multiple medical problems such as ischemic heart disease, left bundle branch block, congestive heart failure, dilated cardiomyopathy and renal impairment who was admitted with an acute abdomen and required emergency surgery. Postoperatively he was unstable hemodynamically and was admitted to the Intensive Care Unit for close observation and further management. A pulmonary artery catheter [PA catheter] was inserted and the patient was managed according to the hemodynamic variables as is discussed