Mechanical Ventilation of the Obstetric Patient

• In previous pearls, we have discussed ventilatory settings to avoid excessive volumes and limit plateau pressures to < 30 cm H₂O
• Importantly, these settings have not be extensively evaluated in pregnant patients
• Some important pearls when ventilating the pregnant patient:
  • Avoid hyperventilation, as this adversely affects uterine blood flow
  • Optimize oxygenation to ensure adequate fetal oxygen delivery (us 100% F_iO₂)
  • In the presence of adequate oxygenation, P_aCO_s values <= 60 mm Hg do not appear to be detrimental to the fetus

References

Lapinsky SE, Posadas-Calleja JG, McCullagh I. Clinical review: Ventilator strategies for obstetric, brain-injured, and obese patients. Crit Care 2009;13:206.