Critical care escalation in the peripartum population; a single center retrospective study at an academic quaternary care center.

OBJECTIVE

Identify the admission characteristics and interventions of patients transferred from a labor and delivery unit to an intensive care unit.

DESIGN

Single-center, retrospective descriptive cohort study at an academic center.

RESULTS

We identified 117 of 48,045 (0.2%) patients who required ICU transfer. Patients with multifetal gestation and cesarean delivery were more likely to be admitted to the ICU. Maternal early warning criteria were positive in 12% of patients in the ICU group compared to 4% of those not admitted to ICU (Odds Ratio [OR] 3.27, 95% Confidence Interval [CI] 1.87 to 5.73; p < 0.001). A quick Sequential Organ Failure Assessment score of 1 and 2 was associated with an OR 6.45 (95% CI 4.28 to 9.72; p < 0.001) and 28.98 (95% CI 6.88 to 122.13; p < 0.001), respectively, for ICU admission compared to a score of 0. The most common indications for ICU admission were postpartum hemorrhage, sepsis, and respiratory failure. Vasoactive medications were required in 51% of patients admitted to the ICU. High flow nasal cannula, non-invasive ventilation, and intubation were described in 3%, 2%, and 40% of patients, respectively. 30% of patients did not require vasoactive infusions or respiratory support during ICU admission.

CONCLUSION

The most common patient characteristics, medical comorbidities, and indications for ICU transfer were consistent with the published literature. Scoring systems performed reasonably well in differentiating patients who required escalation of care. A subset of patients may have benefitted from increased monitoring rather than ICU admission.