Acute Respiratory Failure and Obstetrics


Important causes:

  • asthma
  • pulmonary oedema (multiple causes)
  • infection
  • aspiration
  • venous air embolism
  • amniotic fluid embolism
  • pneumomediastinum/ pneumothorax
  • influenza


  • can use B2 agonists and corticosteroids without adverse fetal outcome


  • determine cause -> can be from tocolysis with beta-agonists
  • NIV, diuresis, O2
  • ETT if required
  • can be due to tocolytics


  • low TV and permissive hypercapnia -> fetal acidosis which reduces oxygen binding to fetal Hb -> try and keep PaCO2 < 45, PaO2 > 70mmHg (no human trials on this to confirm this management)
  • few case reports using NO
  • delivery of fetus doesn’t appear to result in marked improving in respiratory failure

Acid Aspiration

  • high risk: decreased gastric emptying, increased gastric acidity and volume, increased abdominal pressure
  • bronchoscopy for large pieces
  • no role for steroids or BAL
  • only use antibiotics in proven infection

Venous Air Embolism

  • can occur at any time but more common at caesarian section
  • air enters subplacental venous sinuses
  • sudden SOB, CP, tachycardia, hypoxia -> cardiac arrest
  • mill wheel murmur, ST depression
  • FiO2 1.0, left lateral and head down, aspirate CVL if in RV, hyperbaric O2 in those with paradoxical cerebral embolism


  • pregnant patients were notable for severe presentations during the swine flu outbreak
  • expeditious delivery associated with improved
  • treat with tamiflu


  • Peripartum cardiomyopathy: cardiomegaly, S3
  • Venous thromboembolism with PE: swollen, painful calf, R heart failure, ECG – S1Q3T3, ST, R strain, CTPA – filling defect
  • AFE: Haemodynamic collapse, DIC, seizure, bleeding
  • Air embolism: hypotension, cardiac mill wheel murmur
  • Pre-eclampsia: HTN, proteinuria
  • Tocolytic pulmonary oedema: Tocolytic administration, rapid improvement
  • Aspiration pneumonitis: Hx od vomiting or silent aspiration, CXR findings
  • Pneumomediastinum: occurs during delivery
  • Other causes as in non-pregnant patient

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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