Successful use of noninvasive ventilation in pregnancy

Abstract

To the Editor: Acute respiratory failure (ARF) occurs in less than 0.1% of pregnancies; however, it is one of the most common reasons for obstetric admissions to the intensive care unit (ICU) and carries a high mortality for both mother and fetus. Pulmonary physiological and anatomic adaptations during pregnancy affect the overall management, as well as predispose patients to complications during respiratory illness. Pregnancy-related upper airway mucosal oedema may obstruct visualisation of the airway during intubation and can make invasive airway management difficult. The pregnant female requiring endotracheal intubation has a four-fold higher risk of having a difficult airway and an eight-fold higher risk of a failed intubation [1]. The application of noninvasive ventilation (NIV) in the treatment of ARF continues to expand as its benefits are increasingly recognised. NIV is often avoided in pregnancy due to the theoretical risk of aspiration. However, our current knowledge regarding the safety and efficacy of NIV for the management of respiratory failure in pregnancy is based on weak evidence. Only a few case reports and small case series have been published. Given the limited data, we review the current literature and report two cases of pregnant females who developed ARF from acute respiratory distress syndrome (ARDS) and were successfully and safely managed with NIV. A 30-year-old gravida 2 para 1 with an uncomplicated twin pregnancy presented with premature rupture of membranes at 30 weeks of gestation. She had also complained of a dry cough for 1 week prior to presentation and a low grade fever. Corticosteroids, antibiotics and tocolytic therapy were administered. …