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Acute Respiratory Distress Syndrome in Pregnant Women

Rush, Barret MD; Martinka, Pawel MD; Kilb, Brett MD, MPH; McDermid, Robert C. MD; Boyd, John H. MD; Celi, Leo Anthony MD, MPH, MS

doi: 10.1097/AOG.0000000000001907
Contents: Original Research

OBJECTIVE: To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality.

METHODS: We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created.

RESULTS: A total of 55,208,382 hospitalizations from the 2006–2012 Nationwide Inpatient Samples were analyzed. There were 2,808 pregnant patients with ARDS who underwent mechanical ventilation included in the cohort. The overall mortality rate for the cohort was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% confidence interval [CI] 33.1–39.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 57.7–61.4) per 100,000 live births in 2012. Factors associated with a higher risk of death were prolonged mechanical ventilation (adjusted odds ratio [OR] 1.69, 95% CI 1.25–2.28), renal failure requiring hemodialysis (adjusted OR 3.40, 95% CI 2.11–5.47), liver failure (adjusted OR 1.71, 95% CI 1.09–2.68), amniotic fluid embolism (adjusted OR 2.31, 95% CI 1.16–4.59), influenza infection (OR 2.26, 95% CI 1.28–4.00), septic obstetric emboli (adjusted OR 2.15, 95% CI 1.17–3.96), and puerperal infection (adjusted OR 1.86, 95% CI 1.28–2.70). Factors associated with a lower risk of death were: insurance coverage (adjusted OR 0.56, 95% CI 0.37–0.85), tobacco use (adjusted OR 0.53, 95% CI 0.31–0.90), and pneumonia (adjusted OR 0.70, 95% CI 0.50–0.98).

CONCLUSION: In this nationwide study, the overall mortality rate for pregnant patients mechanically ventilated for ARDS was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% CI 33.5–41.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 54.3–65.3) per 100,000 live births in 2012.

Supplemental Digital Content is Available in the Text.The overall mortality rate in pregnant patients with acute respiratory distress syndrome is 9%, with an increase from 36.5 cases per 100,000 live births in 2006 to 59.6 cases per 100,000 live births in 2012, observed.

Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, and the Departments of Anesthesia, Pharmacology and Therapeutics and Orthopaedic Surgery, the Centre for Heart Lung Innovation, and the Division of Critical Care Medicine, St Paul's Hospital, University of British Columbia, Vancouver, and the Department of Critical Care Medicine, Surrey Memorial Hospital, Surrey, British Columbia, Canada; and Harvard T. H. Chan School of Public Health, Harvard University, and Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Corresponding author: Barret Rush, MD, Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada; email: bar890@mail.harvard.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

† Deceased.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.