Factors Associated With Mechanical Ventilation Mortality in Pregnancy

Vasopressor requirement, transfusions, neurologic dysfunction, coagulopathy, and acute respiratory distress syndrome were related to higher mortality after multivariate analysis.

This article is part of Pulmonology Advisor‘s coverage of the CHEST 2018 meeting, taking place in San Antonio, Texas. Our staff will report on medical research related to COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2018.

SAN ANTONIO — Factors associated with mortality related to mechanical ventilation are the same for patients who are pregnant and for those who are not pregnant, according to the results of a study presented at the CHEST Annual Meeting 2018 held from October 6 through October 10 in San Antonio, Texas.

In a retrospective observational study of 6 hospitals in Colombia, Hugo Andres Perez Ramon, MD, and colleagues set out to identify risk factors for maternal mortality in pregnant patients who received mechanical ventilation. This included all pregnant patients admitted to the intensive care unit requiring mechanical ventilation for >24 hours at any point in the 10-year period between 2006 and 2016.

Patients’ medical records were reviewed to identify both demographic data and clinical and laboratory variables. Statistical analysis was conducted by dividing patients into survivors and nonsurvivors. Variables were presented in numeric values and as percentages. To determine the relationship between the categorical variables, researchers used a chi-squared test or Fisher exact test. The team used logistic regression analysis to estimate the association between ventilation and mortality with clinical variables, interventions, and organ dysfunction. A discrimination analysis was also performed by area under the curve (AUC) to determine the ability of clinical and laboratory variables to predict mortality.

During the time period of the study, 2116 intensive care unit admissions occurred, including 299 (14%) pregnant women requiring mechanical ventilation because of respiratory failure. The average age of those admitted was 26 years and the average gestational age was 30.5 weeks. The main diagnoses of pregnant patients requiring mechanical ventilation were obstetric hemorrhage (32.44%), hypertensive disorders of pregnancy (28.42%), maternal sepsis (26.75%), and other causes (12.37%).

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Variables related to higher mortality after the multivariate analysis were vasopressor requirement (odds ratio [OR] 2.81; 95% CI, 1.07-7.39), transfusions (OR 2.26; 95% CI, 1.14-4.48), neurologic dysfunction (OR 2.81; 95% CI, 1.12-7.04), coagulopathy (OR 2.71; 95% CI, 1.30-5.62), and acute respiratory distress syndrome (OR 2.58; 95% CI, 1.22-5.49). Nulliparity was associated with a lower risk for death in patients receiving mechanical ventilation (OR 0.31; 95% CI, 0.16-0.60).

As predictors of mortality, both mean blood pressure and pH showed acceptable discrimination capacity (AUC 0.69; 95% CI, 0.63-0.74 and AUC 0.65; 95% CI, 0.59-0.71, respectively)

The data collected in this study suggest that the causes of death associated with mechanical ventilation are as likely to prove fatal whether or not a patient is pregnant.

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Ramon HAP, Rojas-Suarez J, Borre D, et al. Maternal mortality during mechanical ventilation: a multicenter cohort in Colombia. Presented at: CHEST Annual Meeting 2018; October 6-10, 2018; San Antonio, TX.