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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.
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.
  • Péju E; Service de Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint Jacques, 75014, Paris, France.
  • Belicard F; Université de Paris, Paris, France.
  • Silva S; Institut Cochin, INSERM U1016, CNRS UMR8104, 75006, Paris, France.
  • Hraiech S; Service de Médecine Intensive et Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du faubourg Saint Jacques, 75014, Paris, France.
  • Painvin B; Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire Purpan, 31300, Toulouse, France.
  • Kamel T; Service de Médecine Intensive et Réanimation, AP-HM, Hôpital Nord, Marseille, France.
  • Thille AW; Aix-Marseille Université, Health Service Research and Quality of Life Center (CEReSS), Marseille, France.
  • Goury A; Service de réanimation médicale, service des maladies infectieuses et réanimation médicale, Centre Hospitalier Universitaire de Rennes, Hôpital Pontchaillou, 2 rue Henri le Guilloux, 35033, Rennes Cedex 9, France.
  • Grimaldi D; Service de Médecine Intensive et Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.
  • Jung B; Service de Médecine Intensive et Réanimation, CHU de Poitiers, Poitiers, France.
  • Piagnerelli M; Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Reims, Reims, France.
  • Winiszewski H; Service de soins intensifs CUB-Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
  • Jourdain M; Service de Médecine Intensive et Réanimation, CHU de Lapeyronie, Montpellier, France.
  • Jozwiak M; PhyMedExp, Université de Montpellier, Montpellier, France.
Intensive Care Med ; 48(9): 1185-1196, 2022 09.
Article in English | MEDLINE | ID: covidwho-1990598
ABSTRACT

PURPOSE:

Management and outcomes of pregnant women with coronavirus disease 2019 (COVID-19) admitted to intensive care unit (ICU) remain to be investigated.

METHODS:

A retrospective multicenter study conducted in 32 ICUs in France, Belgium and Switzerland. Maternal management as well as maternal and neonatal outcomes were reported.

RESULTS:

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.

CONCLUSION:

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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy Complications, Infectious / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Infant, Newborn / Pregnancy Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-022-06833-8

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy Complications, Infectious / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study Topics: Long Covid Limits: Adult / Female / Humans / Infant, Newborn / Pregnancy Language: English Journal: Intensive Care Med Year: 2022 Document Type: Article Affiliation country: S00134-022-06833-8