Acute Respiratory Distress Syndrome in Pregnant Women

OBJECTIVE: To estimate the rate of acute respiratory distress syndrome (ARDS) in pregnant patients as well as to investigate clinical conditions associated with mortality. METHODS: We used the Nationwide Inpatient Sample from 2006 to 2012 to identify a cohort of pregnant patients who underwent mechanical ventilation for ARDS. A multivariate model predicting in-hospital mortality was created. RESULTS: A total of 55,208,382 hospitalizations from the 2006-2012 Nationwide Inpatient Samples were analyzed. There were 2,808 pregnant patients with ARDS who underwent mechanical ventilation included in the cohort. The overall mortality rate for the cohort was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% confidence interval [CI] 33.1-39.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 57.7-61.4) per 100,000 live births in 2012. Factors associated with a higher risk of death were prolonged mechanical ventilation (adjusted odds ratio [OR] 1.69, 95% CI 1.25-2.28), renal failure requiring hemodialysis (adjusted OR 3.40, 95% CI 2.11-5.47), liver failure (adjusted OR 1.71, 95% CI 1.09-2.68), amniotic fluid embolism (adjusted OR 2.31, 95% CI 1.16-4.59), influenza infection (OR 2.26, 95% CI 1.28-4.00), septic obstetric emboli (adjusted OR 2.15, 95% CI 1.17-3.96), and puerperal infection (adjusted OR 1.86, 95% CI 1.28-2.70). Factors associated with a lower risk of death were: insurance coverage (adjusted OR 0.56, 95% CI 0.37-0.85), tobacco use (adjusted OR 0.53, 95% CI 0.31-0.90), and pneumonia (adjusted OR 0.70, 95% CI 0.50-0.98). CONCLUSION: In this nationwide study, the overall mortality rate for pregnant patients mechanically ventilated for ARDS was 9%. The rate of ARDS requiring mechanical ventilation increased from 36.5 cases (95% CI 33.5-41.8) per 100,000 live births in 2006 to 59.6 cases (95% CI 54.3-65.3) per 100,000 live births in 2012.