Soins maternels intensifs (Maternal Intensive Care) en Belgique - KCE

148 Maternal Intensive Care in Belgium KCE Reports 94
Pulmonary disorders
• Normal ventilatory function : PaO2 >80 mmHg,
PaCO2 between 30-35 mmHg, SaO2 > 97% vvv
• Mild Asthma www [Subjects were considered to
have mild asthma if they had all of the following:
(1) symptoms (cough, dyspnea, or wheezing) in
the prior 6 months; (2) symptoms on fewer than
8 days during 4 weeks not attributable to upper
respiratory tract infections; (3) FEV1 of 80% or
greater predicted; and (4) were not taking daily
asthma medications. ]
• Every disorder labelled as low-risk by an
pneumologist but not specified as a disorder
requiring a level of intermediate care
Autoimmune disorders
• Rheumatoid arthritis² without medical treatment
• Inflammatory bowel disease, without antecedents
of surgery and corticoid therapy yyy and/or
immunosuppressive agents
• Every disorder labelled as low-risk by an
immunologist/gastroenterologist but not specified
as a disorder requiring a level of intermediate
care
Pulmonary disorders
Moderate asthma: Subjects were considered to have
moderate asthma if they had any of the following: (1)
symptoms on 8 or more days during 4 weeks not
attributable to upper respiratory tract infections; (2)
FEV1 60% to 80% predicted; or (3) requirement for at
least 1 daily asthma medication other than oral
corticosteroids for at least 4 weeks, ie, daily inhaled
-agonist (at least 2 puffs per day), theophylline (at
least 1 dose per day), inhaled ipratropium (at least 4
puffs per day), or at least 2 puffs per day of inhaled
cromolyn, nedocromil, or inhaled steroids
Autoimmune disorders
• Rheumatoid arthritis with medical treatment
standard care
Pulmonary disorders
• Abnormal respiratory values: PaO2 < 80 mmHg,
PaCO2 40 mmHg, SaO2 < 97%
• Severe asthma. Subjects were considered to have
severe asthma if either (1) FEV1 was less than 60%
predicted or (2) they required regular (daily or
every other day) oral corticosteroids for at least 4
weeks
• Pulmonary (arterial) hypertension: in rest >25
mmHg, during exercise > 30 mmHg( xxx )
• Pulmonary transplant
• Severe pulmonary infections (incl. complicated
pneumonia)
• Every disorder labelled as high-risk by a pneumologist
but not specified as a disorder requiring a level of
standard care
Autoimmune disorders
• Anti phospholipid syndrome
• Systemic lupus erythematosus (with clinical
symptoms)
• Inflammatory bowel disease zzz (Crohn / colitis
ulcerosa) aaaa with history of surgery, corticoid
therapy and/or immunosuppressive agents
• Every disorder labelled as high-risk by a
immunologist/gastroenterologist but not specified as
a disorder requiring a level of standard care
vvv Personal communication with dr. Brouckaert (pneumologist UZGent, August 06, 2007)
www Schatz et al. (2003). Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immuno, 112, 283-288.
[National Asthma Education Program Report of the Working Group on asthma and pregnancy. Management of asthma during pregnancy. Bethesda (MD): National Heart, Lung, and
blood institute; 199393-3279A.]
xxx Budev, M, Arroliga, A. & Emery, S. (2005). Exacerbation of underlying disease in pregnancy. Critical care medicine, 33, s313-318.
yyy Personal communication with prof Dr. Devos (gastro-enterologist UZGent, July, 28 th 2007)
zzz Carter, M., Jobo, A. & Travis, S. (2004). Guidelines for the management of inflammatory bowel disease in adults. Retrieved on June, 20, 2007 from the British society of Gastroenterology:
http://www.bsg.org.uk/pdf_word_docs/ibd.pdf
aaaa Vienna Classification” and recent “Montreal modification” (2005.) Retrieved June 12, 2007, from Cebam, tripdatabase: http://www.merck.com/mmpe/sec02/ch018/ch018b.html).
Inflammatory bowel disease aaaa (Crohn / colitis ulcerosa). Crohn’s disease into three principal patterns: (1) primarily inflammatory, which after several years commonly evolves into
either (2) primarily stenotic or obstructing or (3) primarily penetrating or fistulizing.