Acute respiratory distress syndrome in pregnancy.
OBJECTIVE
To summarize the pathophysiology and treatment of acute lung injury and acute respiratory distress syndrome (ARDS) during pregnancy.


METHODS
Review of select articles from MEDLINE, including published abstracts, case reports, observational studies, controlled trials, review articles, and institutional experience.


METHODS
ARDS occurs in pregnancy and may have unique causes. Despite extensive clinical research to improve the management of ARDS, mortality remains high, and few strategies have shown a mortality benefit. Furthermore, in most published studies, pregnancy is an exclusionary criterion, and thus, few treatments have been adequately evaluated in obstetric populations. The treatment of ARDS in pregnancy is extrapolated from studies performed in the general ARDS patient population, with consideration given to the normal physiologic changes of pregnancy. In general, the best support of the fetus is support of the mother. From the age of viability (24-26 wks at most institutions) until full term, decisions regarding delivery should be made based primarily on the standard obstetric indications.


CONCLUSIONS
Little evidence exists regarding the management of ARDS specifically in pregnancy, and thus, treatment approaches must be drawn from studies performed in a general patient population. A multidisciplinary approach involving maternal-fetal medicine, neonatology, anesthesiology, and intensivist clinicians is essential to optimizing maternal and fetal outcomes.
Cole
Daniel E
DE
Pulmonary and Critical Care Flight, Wilford Hall Medical Center, Lackland Air Force Base, TX, USA.
Taylor
Tara L
TL
McCullough
Deirdre M
DM
Shoff
Catherine T
CT
Derdak
Stephen
S
D003422:Critical Care / Q000379:methods; D036861:Delivery, Obstetric; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*