How should the critically ill pregnant patient be managed?

A critically ill pregnant woman in the intensive care unit (ICU) presents many challenges to the intensivist who must consider the normal physiologic changes in pregnancy as well as the needs of the fetus. The trend toward establishing a lowered threshold for ICU admission, combined with improved access to ICU beds, means that the intensivist will care for rising numbers of pregnant or postpartum women. The purpose of this chapter is to assist the clinician in caring for pregnant or postpartum patients, specifically in regard to sepsis or acute respiratory distress syndrome (ARDS). The redefinition of sepsis to emphasize organ dysfunction, and how this is altered in pregnancy, is discussed. Mechanical ventilation in the setting of ARDS is also reviewed. The information presented in this chapter is limited by the exclusion of pregnant women from all major critical care trials. In most cases, it will be necessary to extrapolate from research performed on nonpregnant adults.