tetano
Editor, Senior Moderator
Crit Care Resusc
. 2023 Oct 18;24(3):242-250.
doi: 10.51893/2022.3.OA3. eCollection 2022 Sep 5. Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study
Jean-Christophe Richard[SUP] 1 2 [/SUP], Emilie Frobert[SUP] 3 4 5 [/SUP], Grégory Destras[SUP] 3 4 5 [/SUP], Hodane Yonis[SUP] 1 [/SUP], Mehdi Mezidi[SUP] 1 4 [/SUP], Francois Dhelft[SUP] 1 2 [/SUP], Sophie Trouillet-Assant[SUP] 5 6 [/SUP], Paul Bastard[SUP] 7 8 [/SUP], Adrian Gervais[SUP] 7 8 [/SUP], William Danjou[SUP] 1 [/SUP], Frederic Aubrun[SUP] 9 10 [/SUP], Fanny Roumieu[SUP] 11 [/SUP], Jean-Marc Labaune[SUP] 12 [/SUP], Laurence Josset[SUP] 3 4 5 [/SUP], Antonin Bal[SUP] 3 [/SUP], Bruno Simon[SUP] 3 [/SUP], Jean-Laurent Casanova[SUP] 8 13 14 15 [/SUP], Bruno Lina[SUP] 3 4 5 [/SUP], Jean-Charles Picaud[SUP] 4 12 [/SUP], Corinne Dupont[SUP] 4 16 [/SUP], Cyril Huissoud[SUP] 4 17 [/SUP], Laurent Bitker[SUP] 1 2 [/SUP]
Affiliations
Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy. Design: Single-centre, retrospective observational case-control study. Setting: Adult level 3 ICU in a French university hospital. Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia. Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients. Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not. Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.
. 2023 Oct 18;24(3):242-250.
doi: 10.51893/2022.3.OA3. eCollection 2022 Sep 5. Virological and clinical features of acute respiratory failure associated with COVID-19 in pregnancy: a case-control study
Jean-Christophe Richard[SUP] 1 2 [/SUP], Emilie Frobert[SUP] 3 4 5 [/SUP], Grégory Destras[SUP] 3 4 5 [/SUP], Hodane Yonis[SUP] 1 [/SUP], Mehdi Mezidi[SUP] 1 4 [/SUP], Francois Dhelft[SUP] 1 2 [/SUP], Sophie Trouillet-Assant[SUP] 5 6 [/SUP], Paul Bastard[SUP] 7 8 [/SUP], Adrian Gervais[SUP] 7 8 [/SUP], William Danjou[SUP] 1 [/SUP], Frederic Aubrun[SUP] 9 10 [/SUP], Fanny Roumieu[SUP] 11 [/SUP], Jean-Marc Labaune[SUP] 12 [/SUP], Laurence Josset[SUP] 3 4 5 [/SUP], Antonin Bal[SUP] 3 [/SUP], Bruno Simon[SUP] 3 [/SUP], Jean-Laurent Casanova[SUP] 8 13 14 15 [/SUP], Bruno Lina[SUP] 3 4 5 [/SUP], Jean-Charles Picaud[SUP] 4 12 [/SUP], Corinne Dupont[SUP] 4 16 [/SUP], Cyril Huissoud[SUP] 4 17 [/SUP], Laurent Bitker[SUP] 1 2 [/SUP]
Affiliations
- PMID: 38046204
- PMCID: PMC10692609
- DOI: 10.51893/2022.3.OA3
Objective: Pregnancy is a risk factor for acute respiratory failure (ARF) following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We hypothesised that SARS-CoV-2 viral load in the respiratory tract might be higher in pregnant intensive care unit (ICU) patients with ARF than in non-pregnant ICU patients with ARF as a consequence of immunological adaptation during pregnancy. Design: Single-centre, retrospective observational case-control study. Setting: Adult level 3 ICU in a French university hospital. Participants: Eligible participants were adults with ARF associated with coronavirus disease 2019 (COVID-19) pneumonia. Main outcome measure: The primary endpoint of the study was viral load in pregnant and non-pregnant patients. Results: 251 patients were included in the study, including 17 pregnant patients. Median gestational age at ICU admission amounted to 28 + 3/7 weeks (interquartile range [IQR], 26 + 1/7 to 31 + 5/7 weeks). Twelve patients (71%) had an emergency caesarean delivery due to maternal respiratory failure. Pregnancy was independently associated with higher viral load (-4.6 ± 1.9 cycle threshold; P < 0.05). No clustering or over-represented mutations were noted regarding SARS-CoV-2 sequences of pregnant women. Emergency caesarean delivery was independently associated with a modest but significant improvement in arterial oxygenation, amounting to 32 ± 12 mmHg in patients needing invasive mechanical ventilation. ICU mortality was significantly lower in pregnant patients (0 v 35%; P < 0.05). Age, Simplified Acute Physiology Score (SAPS) II score, and acute respiratory distress syndrome were independent risk factors for ICU mortality, while pregnancy status and virological variables were not. Conclusions: Viral load was substantially higher in pregnant ICU patients with COVID-19 and ARF compared with non-pregnant ICU patients with COVID-19 and ARF. Pregnancy was not independently associated with ICU mortality after adjustment for age and disease severity.