ABSTRACT
Background: Advancing maternal age is increasingly prevalent and is associated with severe maternal morbidity often requiring intensive care unit (ICU) admission. Objectives: To describe maternal ICU admissions at a quaternary care hospital in Montreal, Canada, and evaluate the association between maternal age and composite of: need for invasive interventions, ICU stay > 48â h, or maternal death. Methods: Chart review of ICU admissions during pregnancy/postpartum (2006-2016); logistic regressions to evaluate the impact of age on outcomes. Results: With 5.1 ICU admissions per 1000 deliveries, we included 187 women (mean age 32 ± 6.3 years; 20 (10.7%) ≥ 40 years). The composite outcome occurred in 105 (56.2%) patients; there were two maternal deaths. Age ≥ 40 years increased the odds of invasive interventions (OR 4.03; 95% confidence interval [CI] 1.15-14.1) but not of the composite outcome (OR 2.30; 95% CI 0.66-8.02). Conclusion: Peripartum women aged ≥ 40 years had worse outcomes in ICU, with an increased need for invasive interventions.
ABSTRACT
The aorta plays a central role in the modulation of blood flow to supply end organs and to optimize the workload of the left ventricle. The constant interaction of the arterial wall with protective and deleterious circulating factors, and the cumulative exposure to ventriculoarterial pulsatile load, with its associated intimal-medial changes, are important players in the complex process of vascular aging. Vascular aging is also modulated by biomolecular processes such as oxidative stress, genomic instability, and cellular senescence. Concomitantly with well-established cardiometabolic and sex-specific risk factors and environmental stressors, arterial stiffness is associated with cardiovascular disease, which remains the leading cause of morbidity and mortality in women worldwide. Sexual dimorphisms in aortic health and disease are increasingly recognized and explain-at least in part-some of the observable sex differences in cardiovascular disease, which will be explored in this review. Specifically, we will discuss how biological sex affects arterial health and vascular aging and the implications this has for development of certain cardiovascular diseases uniquely or predominantly affecting women. We will then expand on sex differences in thoracic and abdominal aortic aneurysms, with special considerations for aortopathies in pregnancy.
L'aorte joue un rôle central dans la modulation du débit sanguin pour irriguer les organes cibles et optimiser la charge de travail du ventricule gauche. L'interaction constante entre la paroi artérielle et des facteurs protecteurs et délétères présents dans la circulation, ainsi que l'exposition cumulative à la charge pulsatile ventriculo-artérielle accompagnée des variations de l'épaisseur intima-média, sont des facteurs importants dans le processus complexe du vieillissement vasculaire. Le vieillissement vasculaire est également modulé par des processus biomoléculaires comme le stress oxydatif, l'instabilité génomique et la sénescence cellulaire. Conjointement avec les facteurs de risque cardiométaboliques et spécifiques au sexe bien établis et les sources de stress environnementales, la rigidité artérielle est associée aux maladies cardiovasculaires, qui demeurent la première cause de morbidité et de mortalité chez les femmes à l'échelle mondiale. Les dimorphismes sexuels en ce qui concerne la santé et les maladies de l'aorte sont de plus en plus reconnus et expliquent, du moins en partie, certaines des différences observables liées au sexe dans les maladies cardiovasculaires, ce qui a fait l'objet de cette analyse. Plus précisément, nous verrons le rôle que joue le sexe biologique dans la santé artérielle et le vieillissement vasculaire, et ce que cela implique dans l'évolution de certaines maladies cardiovasculaires qui touchent surtout ou uniquement les femmes. Nous élargirons ensuite l'étude des différences sexuelles aux anévrismes de l'aorte thoracique et abdominale, en accordant une attention particulière aux maladies de l'aorte pendant la grossesse.
ABSTRACT
PURPOSE: Therapeutic hypothermia is the standard treatment for asphyxiated newborns. Since hypocapnia is common in these newborns, the aim of this study was to assess the association among hypocapnia, ventilation, and brain injury. METHODS: We conducted a retrospective cohort study of all asphyxiated newborns treated with hypothermia from 2008 to 2014. Partial pressure of carbon dioxide (pCO2), ventilatory status, and modes of ventilation were recorded during the first 4 days of life. Brain injury was evaluated using brain magnetic resonance imaging. Differences between intubated and nonintubated newborns and between the newborns who developed brain injury or not were assessed. RESULTS: One hundred ninety-eight asphyxiated newborns were treated with hypothermia. During the first 2 days of life, intubated newborns had consistently lower pCO2 levels (respectively, 29.01 ± 8.55, p < .001 on day 1 of life and 33.65 ± 7.12, p = .004 on day 2 of life). Fifty-nine percent of the intubated newborns developed brain injury versus only 43% of the nonintubated newborns (p = .046). The lowest pCO2 levels averaged over the first 4 days of life were significantly decreased in newborns developing brain injury (p = .02) and significantly associated with brain injury severity (p = .01). After adjusting for potential cofounders, the lowest pCO2 averaged over days 1-4 of life remained significantly associated with an increased risk of brain injury (odds ratio [95%CI]: 1.07 [1.00-1.14]; p = .04). CONCLUSIONS: Intubated and ventilated asphyxiated newborns experienced more severe hypocapnia, and had higher incidences of brain injury. Hypocapnia during the first 4 days of life was associated with an increased risk of developing (more severe) brain injury.
