Pneumonia in Pregnancy

OVERVIEW

  • 2 patients
  • treatment dependent on stage of pregnancy (first trimester: avoidance of teratogenicity, third trimester: prevention of pre-term labour)
  • signs of severe sepsis may be masked by normal pregnancy changes
  • these two patients require synchronous resuscitation, evaluation and treatment.

MANAGEMENT

  • Call for help early – obstetrics, anaesthesia, neonatal team

Resuscitate

  • A – intubate if indicated, may be difficult, call for help early
  • B – consider NIV, avoid permissive hypercapnia c/o fetal acidosis, optimize blood flow to placenta
  • C – left lateral position, fluid loading, pressors and inotropes

Early cultures and antibiotics (see below)

Evaluation and Management

Mother

  • history:

-> co-morbidities
-> pregnancy
-> previous pneumonia
-> immunosuppressed

  • examination:

-> volume status
-> complications: empyema, cerebritis
-> other organ involvement

  • investigations:

-> blood cultures
-> CXR: with protection of baby
-> sputum
-> urinary antigens (pneumococcal and legionella)
-> nasopharyngeal swab (H1N1)
-> exclude non respiratory cause of sepsis

  • management:

-> antibiotics: cefuroxime, erythromycin, oseltamivir

Baby

  • viability
  • avoid teratogenicity
  • steroids
  • assessment fetal well being (CTG, U/S)
  • consider LSCS if clinical deterioration

General management

  • nutrition
  • thromboprophylaxis (high risk patient)
  • ulcer prevention
  • aspiration prophylaxis
  • early anaesthetic consult

Disposition

  • early transfer to a tertiary unit
  • ICU admission
  • close liaison with family and teams

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and 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 two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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