TY - JOUR
T1 - Lung ultrasound for detection of pulmonary complications in critically ill obstetric patients in a resource-limited setting
AU - Pisani, Luigi
AU - de Nicolo, Anna
AU - Schiavone, Marcella
AU - Adeniji, Adetunji O.
AU - de Palma, Angela
AU - di Gennaro, Francesco
AU - Emuveyan, Edward Ejiro
AU - Grasso, Salvatore
AU - Henwood, Patricia C.
AU - Koroma, Alimamy P.
AU - Leopold, Stije
AU - Marotta, Claudia
AU - Marulli, Giuseppe
AU - Putoto, Giovanni
AU - Pisani, Enzo
AU - Russel, James
AU - Neto, Ary Serpa
AU - Dondorp, Arjen M.
AU - Hanciles, Eva
AU - Koroma, Michael M.
AU - Schultz, Marcus J.
N1 - Funding Information: Financial support: This study was funded by the Amsterdam University Medical Centers, location AMC and Doctors with Africa-CUAMM, Padova, Italy. Publisher Copyright: © 2021 by The American Society of Tropical Medicine and Hygiene
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15-28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7-14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.
AB - Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15-28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7-14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.
UR - http://www.scopus.com/inward/record.url?scp=85101468220&partnerID=8YFLogxK
U2 - https://doi.org/10.4269/ajtmh.20-0996
DO - https://doi.org/10.4269/ajtmh.20-0996
M3 - Article
C2 - 33319731
SN - 0002-9637
VL - 104
SP - 478
EP - 486
JO - American journal of tropical medicine and hygiene
JF - American journal of tropical medicine and hygiene
IS - 2
ER -