#211 Critical Care in Pregnancy Flashcards
What are the leading causes of ICU admission during pregnancy or postpartum period?
hypertensive disorders and obstetric hemorrhage
In the US, how many obstetric patients out of 1,000 deliveries admitted to the ICU?
1-10 per 1,000
Obstetric patients admitted to the ICU are more likely to be antepartum or postpartum?
Postpartum (63-92%)
What is the maternal death rate after ICU admission in high and low-income countries?
3.3% vs 14% respectively
What are the maternal early warning criteria from the national partnership for maternal safety?
Systolic bp <90 or >160 Diastolic bp >100 HR <50 or >120 RR <10 or >30 O2 sat <95% Oliguria <35cc/hr for 2+ hours Maternal agitation, confusion, or unresponsiveness Pt with PEC w/ non-remitting HA or SOB
What is the definition of sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection. (infection w/ organ dysfunction)
What is septic shock?
Sepsis (infection w/ organ dysfunction) + need for vasopressor to maintain mean arterial pressure greater than 65mmHg and have a serum lactate greater than 2mmol/L after adequate fluid resuscitation.
What is the Quick Sequential Organ Failure Assessment?
Any 2 of the following = pos screen:
- systolic 100mmHg or less
- RR 22 breaths or more
- Altered mental status
What should you do in nonpregnant adults if the Quick Sequential Organ Failure Assessment score is 2 or 3?
Search for signs of organ dysfunction with clinical and laboratory evaluation and consider infection as possible cause
What is the general treatment for sepsis?
Quick recognition, fluid resuscitation, and antibiotic therapy within the first hour
What is acute respiratory distress syndrome, how is it characterized?
Nonspecific response of the lung to a variety of insults, characterized by diffuse inflammation, increased fluid level in the lung d/t increased vascular permeability, and loss of aerated lung units
True or false, pregnant women are at an increased risk for acute respiratory distress syndrome compared to non pregnant women?
True.
In what settings is ARDS more commonly seen in pregnant women?
In setting of sepsis with infections such as influenza and pyelonephritis. Can also been seen as complication of PEC or amniotic fluid embolism
What are criteria for ARDS diagnosis?
Onset of respiratory failure within 1 week of a known clinical event with evidence of bilateral opacities on chest imaging, and no other identifiable etiology such as cardiac failure or fluid overload.
How is the degree of severity of ARDS determined?
Oxygenation, as measured by the partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FIO2) ratio
What type of ventilator setting is used for ARDS?
Low tidal volume ventilation
What is an open ICU model?
When the patient remains the responsibility of her primary or referring team.
What is a closed ICU model?
Patient is transferred to the ICU team, which takes over sole responsibility for managing the patient including writing orders
How does plasma volume/erythrocyte volume change during pregnancy and what effect does this have?
Plasma volume increases by 40-50%, erythrocyte volume increased by 20%. Dilutional anemia, decreased oxygen carrying capacity
How does pregnancy affect the dextrorotation of the heart and what effect does this have?
Increased dextrorotation of the heart. Increased EKG left axis deviation
What does increased estrogen effect on myocardial receptors increase risk of?
Supraventricular arrhythmias
How does supine positioning later in pregnancy affect cardiac output?
Decreases cardiac output by 30 percent
How does pregnancy affect colloid oncotic pressure and what does this put the woman at risk for?
Decreased colloid oncotic pressure. Susceptible to third spacing
How does the pulmonary capillary wedge pressure change in pregnancy and what does this put the woman at risk for?
Decreased pulmonary capillary wedge pressure. Susceptible to pulmonary edema.
