Acute Respiratory Distress Syndrome, Lung Injury, Acute, Obstetric Complication, Pulmonary Disease
Conditions
Brief summary
This study aims at describing the frequency, timing and type of pulmonary complications detected with lung ultrasound in critically-ill parturients in admitted to a high-dependency unit in Freetown, Sierra Leone.
Detailed description
Rationale: The three big 'killers' in parturients, peripartum hemorrhage, sepsis and pre-eclampsia all predispose to pulmonary complications. These complications affect management before, during and after the primary obstetric problem has been solved. A timely diagnosis and thorough follow-up of pulmonary complications may benefit parturients. Lung ultrasound (LUS) is a point-of-care imaging bedside tool increasingly used in the critical care setting that may prove useful in parturients. Objective: To describe frequency, timing and type of pulmonary complications detected with LUS in critically ill parturients in a high-dependency unit (HDU), and to determine the association with outcome. Hypotheses: Pulmonary complications detected by LUS are frequent in parturients admitted to a HDU in a resource-limited setting, and are associated with hospital mortality. Study design: A prospective observational study. Study population: Critically ill parturients admitted to the HDU of the Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Sample size: No formal sample size calculation is performed. Based on current rates of admissions to the HDU of the PCMH the investigators expect to perform LUS in at least 125 patients. Methods: A trained physician performs all 12-region LUS investigations. LUS is performed at admission, after 24 and 48 hours, and when a patient's respiratory condition deteriorates. LUS findings are reported using a standardized semi-quantitative visual LUS scoring method. Main study parameters/primary endpoints: The proportion of critically ill parturients admitted to the HDU of the PCMH with pulmonary complications detected by LUS, including interstitial syndrome, pulmonary consolidation, and pleural effusion.
Interventions
None listed
Sponsors
Mahidol Oxford Tropical Medicine Research Unit
University of Sierra Leone
Doctors with Africa - CUAMM
University of Bari
Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
* Admitted to the HDU of the PCMH during the study period * Verbal informed consent of the patient or his/her formal representative
Exclusion criteria
* Lung ultrasound not feasible, e.g., due to electricity breakdown, or absence of the trained sonographer.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of parturients with pulmonary complications | From admission to 48 hours later | proportion of parturients with pulmonary complications detected by LUS during stay in the HDU. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Description of lung ultrasound findings | From admission to 48 hours later | Precise description of ultrasound findings (proportion of patients with a normal lung, interstitial syndrome, lung consolidation, pleural effusion) |
| Description of diagnoses made with lung ultrasound | From admission to 48 hours later | Proportion of patients with a diagnosis of pneumonia, acute respiratory distress syndrome, fluid overload, no pulmonary complication. |
| Relative risk of death in patients with a pulmonary complication | On the day of HDU discharge or death, whichever came first, assessed up to 12 weeks after enrollment | Risk of death in the group with pulmonary complication divided by the risk of death in parturients without a pulmonary complication |
Countries
Sierra Leone
Outcome results
None listed