Management of Pneumonia with Respiratory Failure in Pregnancy

Assessment of Severity

Oxygen saturation <92% or PaO2 <8 kPa indicates significant hypoxemia requiring immediate oxygen therapy, according to the European Respiratory Society guidelines 1
Signs of impending respiratory failure include sustained tachypnea, inadequate blood pressure, need for pharmacologic support of blood pressure or perfusion, as recommended by the Infectious Diseases Society of America 2
Pulse oximetry measurement ≤92% with inspired oxygen of ≥0.50 indicates severe disease requiring ICU admission, based on the guidelines from the Infectious Diseases Society of America 2
Criteria for ICU admission include acute respiratory failure, severe sepsis or septic shock, and radiographic extension of infiltrates, as stated by the European Respiratory Society 3

Provide appropriate oxygen therapy with monitoring of oxygen saturations and FiO2 with the aim to maintain PaO2 >8 kPa and SaO2 >92%, as recommended by the British Thoracic Society 1
High concentrations of oxygen can safely be given in uncomplicated pneumonia, according to the British Thoracic Society 1
Assess for volume depletion and provide intravenous fluids as needed, based on the guidelines from the British Thoracic Society 1
Monitor fluid balance carefully to avoid fluid overload which may worsen respiratory status, as stated by the British Thoracic Society 1

Continuous cardiorespiratory monitoring is essential for pregnant women with respiratory failure, as recommended by the Infectious Diseases Society of America 2
Monitor temperature, respiratory rate, pulse, blood pressure, mental status, oxygen saturation, and inspired oxygen concentration at least twice daily, more frequently in severe cases, based on the guidelines from the British Thoracic Society 1
Regular arterial blood gas measurements to guide oxygen therapy and assess ventilatory status, as recommended by the British Thoracic Society 1

Initiate empiric antimicrobial therapy immediately upon diagnosis, according to the British Thoracic Society 1

Blood cultures should be performed in all patients with pneumonia requiring hospitalization, as recommended by the European Respiratory Society 3
Diagnostic thoracentesis should be performed when a significant pleural effusion is present, based on the guidelines from the European Respiratory Society 3
Consider bronchoscopy in selected cases to remove retained secretions, obtain samples for culture, and exclude endobronchial abnormality, as stated by the British Thoracic Society 1

Nutritional support should be provided, especially in prolonged illness, according to the British Thoracic Society 1
Maintain regular moderate intensity exercise as tolerated to prevent deconditioning, based on the guidelines from the European Respiratory Society 4
Physiotherapy for airway clearance should be continued throughout pregnancy to prevent sputum retention, as recommended by the European Respiratory Society 4
Relief of pleuritic pain using simple analgesia such as paracetamol, according to the British Thoracic Society 1

The growing fetus impacts the respiratory system, potentially limiting airway clearance in the second and third trimesters, as stated by the European Respiratory Society 4
Modification to airway clearance techniques and physical exercise will be required as pregnancy progresses, based on the guidelines from the European Respiratory Society 4
Adequate pain relief during labor is a high priority for women with respiratory diseases, according to the European Respiratory Society 4

Vaccination against bacterial pathogens including S. pneumoniae should be considered in high-risk pregnant women, as recommended by the Infectious Diseases Society of America 5

Resolution of respiratory failure with stable oxygen requirements, according to the British Thoracic Society 1
Ability to maintain adequate oxygenation on room air or stable supplemental oxygen, based on the guidelines from the British Thoracic Society 1
Appropriate follow-up arrangements in place, as recommended by the Infectious Diseases Society of America 5