Critical Matters Critical Care in Pregnancy (Part 1)
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Jun 12, 2019 Dr. Stephen Lapinsky, a practicing intensivist and professor with expertise in critical illness during pregnancy, sheds light on the complexities of caring for critically ill pregnant patients. He discusses the unique challenges they face, including respiratory and cardiac physiologic changes that complicate ICU care. Lapinsky also elaborates on common ICU indications, the management of hypertensive disorders and obstetric hemorrhage, and the best practices for team coordination in critical situations. His insights are crucial for improving outcomes in maternal care.
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Pregnancy Physiology Guides ICU Decisions
- Pregnant patients have predictable physiological changes that affect ICU care and diagnostics.
- Treat the mother as you would a non-pregnant patient because maternal benefit usually equals fetal benefit.
Prepare For Difficult Airway And Ventilation
- Anticipate airway edema and increased minute ventilation in pregnant patients and prepare for difficult intubation.
- Use a smaller endotracheal tube and expect lower PaCO2 (~30 mmHg) when managing ventilation.
Hemodynamics And Renal Baseline Shift
- Cardiac output increases early in pregnancy and peaks around 28 weeks, which can unmask valvular or pulmonary vascular disease.
- Normal pregnancy lowers baseline creatinine via raised GFR, so small creatinine rises are significant.