Critical care clinics
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Critical care clinics · Oct 2004
ReviewCardiopulmonary resuscitation and somatic support of the pregnant patient.
Cardiopulmonary arrest during pregnancy is a rare event that critical care clinicians must be prepared to manage. The causes of cardiopulmonary arrest during pregnancy, recommended modifications to cardiopulmonary resuscitation protocols that are specific to pregnancy, indications for and timing of perimortem cesarean delivery, and the expected fetal outcomes are reviewed. ⋯ Prolonged somatic support of pregnant patients who are brain dead presents specific management challenges, but has been accomplished. The physiologic changes that occur after brain death and recommendations for somatic support of the brain dead pregnant patient also are reviewed.
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Hypertension in pregnancy represents a spectrum of clinical entities, including pregnancy-induced hypertension (PIH), preeclampsia, eclampsia, and hemolysis, elevated liver enzyme levels, low platelet count syndrome. Although hypertension is a common denominator in this group of disorders, the pathogenesis, clinical features, and clinical course of these disorders is variable and somewhat distinct. ⋯ The incidence and prevalence of preeclampsia and eclampsia is decreasing worldwide. This decrease partly may be caused by the improved treatment of PIH and improved obstetrical services.
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Critical care clinics · Oct 2004
ReviewAcute lung injury and acute respiratory distress syndrome in pregnancy.
Acute respiratory failure can be the result of a variety of clinical conditions, such as congestive heart failure, pneumonia, pulmonary embolism, exacerbation of obstructive lung diseases, and acute respiratory distress syndrome (ARDS). This article focuses on developments related to acute lung injury and ARDS and reviews epidemiology, pathogenesis and therapeutic advances with an emphasis on the obstetric population. A brief discussion of tocolytic-induced pulmonary edema, preeclampsia, venous air embolism, and aspiration-related ARDS is included. Management of pregnant women with ARDS is outlined.
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The diagnosis of peripartum cardiomyopathy should be considered whenever women present with heart failure during the peripartum period. This cardiomyopathy is distinguished by rapid onset, occurrence in the peripartum period, and significant improvement in up to 50% of affected women. The cause and pathogenesis of this dilated cardiomyopathy remain unknown. ⋯ Worsening of heart failure may require management in the ICU with support by vasodilators, inotropes, and ventricular assist devices. Patients with severe ventricular dysfunction are less likely to survive and recover normal cardiac function. Subsequent pregnancies may provoke a recurrence, even in patients who apparently recover.
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Sepsis is the leading cause of death in critically ill patients in the United States. Improvements in the critical care management of septic shock have led to a decrease in the mortality rate in the past decade. ⋯ Pregnant women as a group are younger and have fewer comorbid conditions. Though little is known regarding the treatment of sepsis and septic shock in pregnancy, the same principles and treatment modalities discussed in this article should govern the management of pregnant women.