Ventilasi Mekanik pada Acute Respiratory Distress Syndrome (ARDS) selama Kehamilan: Dampak pada Keseimbangan Asam-Basa Ibu-Janin dan Perkembangan Janin
Abstract
Tantangan dalam penggunaan ventilasi mekanik pada Acute Respiratory Distress Syndrome (ARDS) selama kehamilan adalah pencapaian strategi perlindungan paru (lung protective strategy) pada ibu dengan tetap mempertahankan kondisi optimal bagi perkembangan janin. Alkalosis respirasi ringan pada kehamilan normal membantu mengeluarkan CO2 dan bikarbonat dari hasil metabolisme janin pada saat fungsi pernapasan janin belum berfungsi didalam intrauterine. Permissive hypercapnia dan asidosis sampai dengan 7,2 sebagai bagian lung protective strategy untuk melindungi paru-paru dan meningkatkan oksigenasi ibu dapat menyebabkan kondisi yang tidak menguntungkan bagi pertumbuhan janin. Oleh karena itu, menjaga PaCO2, pH dan PaO2 ibu untuk memberikan kondisi optimal bagi janin harus dipertimbangkan dan dilakukan pada saat melakukan prinsip penatalaksanaan lung protective strategy. Sampai saat ini belum ada panduan dan konsensus terkait lung protective strategy pada ARDS selama kehamilan. Pemahaman terhadap perubahan fisiologi selama kehamilan, terutama efek keseimbangan asam basa ibu terhadap aliran darah uteroplasenta dan keseimbangan asam basa janin, menjadi sangat penting untuk mencapai luaran terbaik bagi ibu dan janin. Posisi tengkurap atau prone dengan sedasi dan paralisis yang tepat selama kehamilan, terbukti aman dan efektif untuk mengatasi hipoksemia berat pada penggunaan ventilasi mekanik, untuk mencapai target tersebut tanpa membuat perkembangan janin terganggu.
Downloads
References
Ernesto DT, Tania ML, Manuel GGA, Jorge LF, Orlando PNR, Jorge CMD, et al. Considerations for mechanical ventilation in the critically III obstetric patient. critical care obstetrics and gynecology. [Internet]. ImedPub J. 2020;6(4:10):1-8. [cited 2025 Jul 23];. Tersedia dari: https://obstetrics.imedpub.com/articles/considerations-for-mechanical-ventilation-in-the-critically-ill-obstetric-patient.pdf
Pandya ST, Krishna SJ. Acute respiratory distress syndrome in pregnancy. Indian J Crit Care Med. 2021;25(S3):S241–7. Doi: 10.5005/jp-journals-10071-24036
Reddi AS. Acid-Base disorders in pregnancy. Dalam: Acid-base disorders: Clinical Evaluation and Management. Springer, Cham; 2020.
Vinturache A, Khalil A. Maternal physiological changes in pregnancy. Dalam: Fetal development and maternal adaptation. Glob Libr Women's Med [Internet]. 2021 [cited 2026 Jan 8]. Tersedia dari: https://www.glowm.com/article/id/411323
Lomauro A, Aliverti A, Frykholm P, Alberico D, Persico N, Boschetti G, et al. Adaptation of lung, chest wall, and respiratory muscles during pregnancy: preparing for birth. J Appl Physiol [Internet]. 2019;127:1640–50. Doi: 10.1152/japplphysiol.00035.2019
Lapinsky SE, Vasquez DN. Acute respiratory failure in pregnancy. Crit Care Clin. 2024 1;40(2):353–66. Doi: https://doi.org/10.1016/j.ccc.2024.01.005
Garland A, Hopton P. Airway closure in anaesthesia and intensive care. BJA Educ. 2022 ;22(4):126–30. Doi: 10.1016/j.bjae.2021.12.001
Hedenstierna G, Chen L, Brochard L. Airway closure, more harmful than atelectasis in intensive care?. Intensive Care Med. 2020;46(12): 2373–376. Doi: 10.1007/s00134-020-06144-w
Ejikeme C, Nandakumar V, Gotur D. Respiratory physiological changes in pregnancy. Respir Med. 2025; 246:108245. Doi: 10.1016/j.rmed.2025.108245
Ahmed A. Fetomaternal acid–base balance and electrolytes during pregnancy. Indian J Crit Care Med. 2021;25(S3):S193–9. Doi: 10.5005/jp-journals-10071-24030
Jakob SM, Kosonen P, Ruokonen E, Parviainen I, Takala J. The haldane effect - An alternative explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth. 1999;83(5):740–6. Doi: 10.1093/bja/83.5.740
Duhaim A, Almatroudi TA, Alghidani ZA, Alhunayni AS, Salama MH. Pharmacokinetics of maternal drug administration: insights into placental transfer and fetal exposure. J Pharm Bioallied Sci. 2024;16(Suppl 4):S3743–5. Doi: 10.4103/jpbs.jpbs_1215_24
Abati I, Micaglio M, Giugni D, Seravalli V, Vannucci G, Di Tommaso M. Maternal oxygen administration during labor: A controversial practice. Children. 2023;10(8): 1-11. Doi: https://doi.org/10.3390/children10081420
Zhao H, Wang G, Lyu J, Zhang X, An Y. Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China. BMC Pregnancy Childbirth. 2021;21(1)1–9. Doi: 10.1186/s12884-020-03524-4
Wang B, Zeng H, Liu J, Sun M. Effects of prenatal hypoxia on nervous system development and related diseases. Front Neurosci.2021; 15:755554. Doi: 10.3389/fnins.2021.755554
Lim MJ, Lakshminrusimha S, Hedriana H, Albertson T. Pregnancy and severe ARDS with COVID-19: Epidemiology, diagnosis, outcomes and treatment. Semin Fetal Neonatal Med. 2023;28(1): 1–13. Doi: 10.1016/j.siny.2023.101426
Lapinsky SE, Rojas-Suarez J. Acute lung injury and ARDS during pregnancy. Dalam: The Continuous Textbook of Women’s Medicine Series – Obstetrics Module. Obstetric Emergencies. Glob Libr Women’s Med. 2021; 13. Doi: 10.3843/GLOWM.41382
Papadopoulou D, Psathas T, Chantziara V, Devadze G, Kyriakoudi A, Ioannidou I, et al. Similarities and differences of acute respiratory distress syndrome (ARDS) caused by H1N1 versus SARS-CoV-2 in pregnancy: A systematic review of cohort studies. Pneumon. European Publishing; 2024;37(2). Doi: 10.18332/pne/185362
Eid J, Stahl D, Costantine MM, Rood KM. Oxygen saturation in pregnant individuals with COVID-19: time for re-appraisal?. Am J Obstet Gynecol. 2022;226(6):813–6. Doi: 10.1016/j.ajog.2021.12.023
Murphy C, Ryan DM, Drew T. Respiratory disease in pregnancy. BJA Educ. 2025;25(12):481–92.
Kislovskiy Y, Hauspurg A, Donadee C, Sakamoto S, Murugan R. Lung protective ventilation during pregnancy: An observational cohort study. [Internet]. AJP Rep. 2024 14(2):e111–e119. [cited 2025 Sep 30]. Tersedia dari: https://pmc.ncbi.nlm.nih.gov/articles/PMC11027493/
Vasquez DN, Giannoni R, Salvatierra A, Cisneros K, Lafosse D, Escobar MF, et al. Ventilatory parameters in obstetric patients With COVID-19 and impact of delivery: A multicenter prospective cohort study. Chest. 2023;163(3):554–66. Doi: 10.1016/j.chest.2022.10.010
Hamill ME, Hertel KA, Perez-Fernandez J, editors. Fundamental critical care support. Seventh Edition [Internet]. Mount Prospect, Illinois: Society of Critical Care Medicine; 2021. Tersedia dari: www.sccm.org
Demiselle J, Calzia E, Hartmann C, Messerer DAC, Asfar P, Radermacher P, et al. Target arterial PO2 according to the underlying pathology: a mini-review of the available data in mechanically ventilated patients. Ann Intensive Care. 2021;11(1):88. Doi: 10.1186/s13613-021-00872-y
Fossali T, Pavlovsky B, Ottolina D, Colombo R, Basile MC, Castelli A, et al. Effects of prone position on lung recruitment and ventilation-perfusion matching in patients with covid-19 acute respiratory distress syndrome: a combined ct scan/electrical impedance tomography study. Crit Care Med. 2022;50(5):723–32. Doi: 10.1097/CCM.0000000000005450
Osmundo Jr GS, Paganotti CF, da Costa RA, Dos Santos Silva TH, Bombonati PC, Sa Malbouisson LM , et al. Prone positioning: A safe and effective procedure in pregnant women presenting with severe acute respiratory distress syndrome. Vaccines. 2022;10(12): 1–9. Doi: 10.3390/vaccines10122182
Tolcher MC, McKinney JR, Eppes CS, Muigai D, Shamshirsaz A, Guntupalli KK, et al. Prone positioning for pregnant women with hypoxemia due to coronavirus disease 2019 (COVID-19). Vol. 136, Obstet Gynecol. 2020;136(2):259–61. Doi: 10.1097/AOG.0000000000004012.
Hsu CW, Liu SM, Yang CY, Sun SF, Kuo SH, Chu KA. Different duration of prone positioning treatment for patients with acute respiratory distress syndrome in intensive care unit patients: A prospective randomized clinical study. J Clin Med. 2025;14(20):1–12. Doi: 10.3390/jcm14207261
Jurnal Anestesi Obstetri Indonesia
