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Systemic Inflammatory Response Syndrome, Organ Failure, and Outcome in Critically Ill Obstetric Patients Treated in an ICU^*

Bekele Afessa, MD, FCCP; Bethany Green, DO; Isaac Delke, MD and Kathryn Koch, MD, FCCP

^* From the Department of Internal Medicine (Drs. Afessa, Green, and Koch) and the Department of Obstetrics and Gynecology (Dr. Delke), University of Florida Health Science Center, Jacksonville, FL. Dr. Green is currently at the University of Washington, Seattle, WA.

Correspondence to: Bekele Afessa, MD, FCCP, Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905

Study objectives: To determine the incidence of systemic inflammatory response syndrome (SIRS) and organ failure and to describe the outcomes in critically ill obstetric patients who have been treated in medical ICUs.

Design: Retrospective review.

Setting: A multidisciplinary ICU at a tertiary-care institution.

Methods: We collected data on 74 obstetric patients who were admitted consecutively to the ICU from January 1991 through December 1998. Acute physiology and chronic health evaluation (APACHE) II scores were calculated. A p value < 0.05 was considered to be significant.

Measurements and results: Fifty-eight percent of patients were admitted to the ICU postpartum. Their mean (± SD) age was 25.9 ± 7.0 years, and 64% were African American and 34% were white. Fifty percent had preexisting medical conditions. Their mean APACHE II score was 14.0 ± 5.9, and their predicted mortality rate was 17.6%. The most common reason for admission was respiratory insufficiency. Preeclampsia was present in 38% of patients, and hemolytic anemia, elevated liver enzymes, and low platelet count syndrome were present in 7% of patients. SIRS developed in 59% of patients. Patients with SIRS had longer ICU stays (p = 0.0008). Organ failure developed in 65% of patients, and ARDS developed in 15% of patients. Invasive mechanical ventilation was required in 45% of patients, and pulmonary artery catheterization was required in 35% of patients. The in-hospital mortality rate was 2.7%. There were five spontaneous abortions and eight perinatal deaths.

Conclusions: The most common reason for admission to the ICU of critically ill obstetric patients was respiratory failure. Despite the severity of illness and the development of SIRS and organ failure in most patients, the mortality rate was low.

Key Words: APACHE • critical illness • eclampsia • hemodynamics • ICUs • multiple organ failure • obstetrics • respiratory insufficiency • sepsis

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