Non invasive ventilation (NIV) – A safe option for
Respiratory Failure in Pregnancy? A retrospective review of 107 cases
INTRODUCTION: Maternal hypoxia is one of the common reasons for obstetric admissions to the
intensive care unit (ICU) and carries a high foeto maternal morbidity and mortality. The intrinsic
difficulty in airway management of obstetric population makes NIV a better option. We report a
retrospective analysis of 107 cases of maternal hypoxia successfully managed with NIV.
Aim: To analyze the efficacy and safety of NIV with a protocolised approach, in pregnant patients
admitted in OCCU with respiratory failure.
Methodology:
This is a retrospective analysis of pregnant patients with respiratory distress, admitted in Fernandez
hospital, over a period of 10yrs from Jan 2005 – December 2014. The data is obtained from hospital
records and ICU records database.
Result:
The mean age 28+- 2, 21.3% had BMI > 33, 73% of them were G2 or more. 12%were in 1st, 58 % in
2ndand 30% in 3rdtrimester.
Indications for NIV:
NIV as the Primary Modality
1.Acute Pulmonary Oedema (APO) - 34 patients (26
Accelerated hypertension; 8 Heart Disease)
2. Community Acquired Pneumonia (CAP) - 6
NIV as the Supportive Modality
3. H1N1 - 2
3. Eclampsia with aspiration Pneumonia - 4
4. Obstetric disorders with ARDS - 4
5. Acute chest syndrome (Sickle Cell Disease) - 1
6.Ovarian malignancy with pregnancy in ARF - 1
4. OSAS -7
5. OHSS: 2
6. Prior to ICU intubations to improve FRC - 6
1. As weaning mode following ARDS – 33
2. Post massive transfusion with atelectasis - 8
Observation: 85% had initial PaO2/ FiO2 ≤ 200. Mean APACHE II Score was 19. Average duration of
NIV: Continuous – 11hrs / intermittent 48 ± 6hrs. Mean ICU stay was 5.5 days and mean Total
Hospital Stay was 11.8days.
Results: Increase in PaO2/ FiO2 ratio is taken as the end point. Fall in PaO2/FiO2 < 200 or a clinical
deterioration are taken as failed NIV. Failed NIV - 4 patients.
Of 107, 88 were > 28wks of gestation, & 83 neonates (94.93%) survived. No documented aspiration
or ulcerations noted. Maternal mortality was nil in our series.
Conclusion: NIV can be used successfully both as a primary ventilator mode in acute respiratory
failure in pregnancy and also as a supportive mode to enhance the respiratory mechanics with
protocolised approach. However large prospective multicentric study is proposed to document its
universal safety without compromising the materno foetal safety.