Implications for the pregnant patient

Critical illness requiring admission to an intensive care unit (ICU) is a relatively uncommon complication of pregnancy, accounting for less than 1% of ICU admissions (1). A few illnesses, such as eclampsia, hemorrhage, the HELLP syndrome (hemolysis, elevated liver enzymes, low platelets), amniotic fluid embolism, and tocolytic-induced pulmonary edema, are specific to the pregnant patient and may lead to ICU admission. However, it is slightly more common that nonobstetric diseases occurring in the pregnant patient lead to life-threatening illness. It is not within the scope of this article to review comprehensively all problems that lead to critical illness in the gravid patient. A recent State-of-the-Art in the Journal provides an excellent overview of this broad topic (2). The management of the critically ill pregnant patient has not changed dramatically in the past decade. Unfortunately, there is a paucity of recent data concerning critically ill obstetric patients. This article concentrates on new information regarding the pregnant patient and recent advances in critical care that will he applied to the pregnant patient even though these studies did not include pregnant patients. These topics include severity of illness and mortality, asthma, pulmonary edema, ventilatory strategies, eicosanoids and nitric oxide, and resuscitation.