COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study.

BACKGROUND: Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS: A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS: Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS: This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.

Emerging modes of ventilation in the intensive care unit.

Potentially harmful effects of positive pressure mechanical ventilation have been recognized since its inception in the 1950s. Since then, the risk factors for and mechanisms of ventilator-induced lung injury (VILI) have been further characterized. Publication of the ARDSnet tidal volume trial in 2000 demonstrated that a ventilator strategy limiting tidal volumes and plateau pressure in patients with acute respiratory distress syndrome was associated with a 22% reduction in mortality. Since then, a variety of ventilator modes have emerged seeking to improve gas exchange, reduce injurious effects of ventilation, and improve weaning from the ventilator. We review here emerging ventilator modes in the intensive care unit (ICU). Airway pressure release ventilation seeks to optimize alveolar recruitment and maintain spontaneous ventilatory effort. It is associated with improved indices of respiratory and cardiovascular physiology, but data to support outcome benefit are lacking. High-frequency oscillatory ventilation is associated with improvements in gas exchange, but outcome data are conflicting. Extracorporeal modes of ventilation continue to evolve, and extra-corporeal CO(2) removal is a technique that could be used in non-specialist ICUs. Proportional-assist ventilation and neutrally adjusted ventilator assist are modes that vary level of assistance with patient ventilatory effort. They result in greater patient-ventilator synchrony, but at present there is no evidence of a reduction in the duration of mechanical ventilation or outcome benefit. Although the use of many of these modes is likely to increase in intensive care units, further evidence of a beneficial effect is desirable before they are recommended.