ABSTRACT
BACKGROUND: Current evidence on obstetric patients requiring advanced ventilatory support and impact of delivery on ventilatory parameters is retrospective, scarce, and controversial. RESEARCH QUESTION: What are the ventilatory parameters for obstetric patients with COVID-19 and how does delivery impact them? What are the risk factors for invasive mechanical ventilation (IMV) and for maternal, fetal, and neonatal mortality? STUDY DESIGN AND METHODS: Prospective, multicenter, cohort study including pregnant and postpartum patients with COVID-19 requiring advanced ventilatory support in the ICU. RESULTS: Ninety-one patients were admitted to 21 ICUs at 29.2 ± 4.9 weeks; 63 patients (69%) had delivered. Maximal ventilatory support was as follows: IMV, 69 patients (76%); high-flow nasal cannula, 20 patients (22%); and noninvasive mechanical ventilation, 2 patients (2%). Sequential Organ Failure Assessment during the first 24 h (SOFA24) score was the only risk factor for IMV (OR, 1.97; 95% CI, 1.29-2.99; P = .001). Respiratory parameters at IMV onset for pregnant patients were: mean ± SD plateau pressure (PP), 24.3 ± 4.5 cm H2O; mean ± SD driving pressure (DP), 12.5 ± 3.3 cm H2O; median static compliance (SC), 31 mL/cm H2O (interquartile range [IQR], 26-40 mL/cm H2O); and median Pao2 to Fio2 ratio, 142 (IQR, 110-176). Respiratory parameters before (< 2 h) and after (≤ 2 h and 24 h) delivery were, respectively: mean ± SD PP, 25.6 ± 6.6 cm H2O, 24 ± 6.7 cm H2O, and 24.6 ± 5.2 cm H2O (P = .59); mean ± SD DP, 13.6 ± 4.2 cm H2O, 12.9 ± 3.9 cm H2O, and 13 ± 4.4 cm H2O (P = .69); median SC, 28 mL/cm H2O (IQR, 22.5-39 mL/cm H2O), 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O), and 30 mL/cm H2O (IQR, 24.5-44 mL/cm H2O; P = .058); and Pao2 to Fio2 ratio, 134 (IQR, 100-230), 168 (IQR, 136-185), and 192 (IQR, 132-232.5; P = .022). Reasons for induced delivery were as follows: maternal, 43 of 71 patients (60.5%); maternal and fetal, 21 of 71 patients (29.5%); and fetal, 7 of 71 patients (9.9%). Fourteen patients (22.2%) continued pregnancy after ICU discharge. Risk factors for maternal mortality were BMI (OR, 1.10; 95% CI, 1.006-1.204; P = .037) and comorbidities (OR, 4.15; 95% CI, 1.212-14.20; P = .023). Risk factors for fetal or neonatal mortality were gestational age at delivery (OR, 0.67; 95% CI, 0.52-0.86; P = .002) and SOFA24 score (OR, 1.53; 95% CI, 1.13-2.08; P = .006). INTERPRETATION: Contrary to expectations, pregnant patient lung mechanics were similar to those of the general population with COVID-19 in the ICU. Delivery was induced mainly for maternal reasons, but did not change ventilatory parameters other than Pao2 to Fio2 ratio. SOFA24 score was the only risk factor for IMV. Maternal mortality was associated independently with BMI and comorbidities. Risk factors for fetal and neonatal mortality were SOFA24 score and gestational age at delivery.
ABSTRACT
RATIONALE: The purpose of the current study was to analyze the influence of coronavirus awareness, psychological stress responses, and sociodemographic variables on mental health indicators (somatization, depression, and anxiety) in residents of Honduras, Chile, Costa Rica, Mexico, and Spain. METHODS: The study used a quantitative, cross-sectional approach. Data was collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and sociodemographic questions. The total sample size consisted of 1559 respondents from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain (9%). RESULTS: The most common stress domains correspond to family (22.97%), financial (22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), peer group (7.63%), and religious concerns (3.69%). These domains are significantly associated with the respondent's country, sex, employment status, and being or not a health worker. Respondents who reported confinement stress also reported higher scores in anxiety, depression, and somatization. The Global Severity Index was significantly predicted by confinement stress, health, academic, and leisure time-related stress, sex, age, being a health worker, COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors were employment status, the number of people at home, presence of older adults and children at home, financial, peer group, family, and religious concerns; the regression model had an R2 of 0.26. Similar analyses were conducted for somatization, depression, and anxiety subscales. CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of the general population, particularly regarding anxiety, depression, and somatization. Specific populations, such as women and healthcare workers, are at particular risk of suffering a deterioration in mental wellbeing. The implications of the study for public policy are discussed.