Advertisement

Pulmonary Fibrosis

  • J. Nguyen
  • L. Coleman
  • M. ZakowskiEmail author
Chapter

Abstract

Pulmonary fibrosis is characterized by scarring of the lung parenchyma resulting in progressive hypoxemia and may be caused by over 200 diseases including acquired (e.g., silica dust), systemic inflammation (e.g., lupus), or genetic (e.g., cystic fibrosis). Pulmonary fibrosis in women of childbearing age may be as high as 1:5000 but during pregnancy more commonly secondary to mixed connective tissue diseases. Decreasing lung volumes as the uterus enlarges during pregnancy may be poorly tolerated in the parturient with pulmonary fibrosis, and women with severe lung disease should be counseled of maternal risks. The anesthetic goal is to decrease oxygen consumption and hyperventilation during labor which can be achieved with epidural analgesia. Avoidance of respiratory acidosis and hypoxemia is important to prevent worsening pulmonary hypertension.

Keywords

Pulmonary fibrosis Pregnancy lupus Cystic fibrosis Idiopathic pulmonary fibrosis Interstitial lung disease Pulmonary hypertension 

References

  1. 1.
    Bédard E, Dimopoulos K, Gatzoulis MA. Has there been any progress made on pregnancy outcomes among women with pulmonary arterial hypertension? Eur Heart J. 2009;30(3):256–65.CrossRefGoogle Scholar
  2. 2.
    Budev MM, Arroliga AC, Emery S. Exacerbation of underlying pulmonary disease in pregnancy. Crit Care Med. 2005;33(10):S313–8.CrossRefGoogle Scholar
  3. 3.
    Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med. 2011;32:1–13.CrossRefGoogle Scholar
  4. 4.
    Hong JM, Kim E, Kim HK, Lee DW, Baik JS, Lee JY. Combined spinal–epidural anesthesia for radical hysterectomy in a patient with Sjőgren syndrome with progressive interstitial lung disease. Spring. 2016;5(1):1737.Google Scholar
  5. 5.
    Hoshino T, Kita M, Takahashi T, Nishimura T, Yamakawa M. Management of two pregnancies in a woman with mixed connective tissue disease, pulmonary fibrosis, frequent pneumothorax and oxygen inhalation therapy along with a published work review. J Obstet Gynaecol Res. 2008;34(4 Pt 2):613–8.CrossRefGoogle Scholar
  6. 6.
    Lapinsky SE, Tram C, Mehta S, et al. Restrictive lung disease in pregnancy. Chest. 2014;145(2):394–8.CrossRefGoogle Scholar
  7. 7.
    Lindeman KS. Respiratory disease. In: Chestnut DH, Wong CA, Tsen LC, Ngan Kee WD, Beilin Y, Mhyre JM, Naveen N, editors. Chestnut’s obstetric anesthesia: principles and practice. 5th ed. Philadelphia: Mosby/Elsevier; 2014. p. 1179–94.Google Scholar
  8. 8.
    King TE Jr. Restrictive lung disease in pregnancy. Clin Chest Med. 1992;13(4):607–22.PubMedGoogle Scholar
  9. 9.
    King TE Jr. Interstitial lung diseases. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J, editors. Harrison’s principles of internal medicine. 19th ed. New York: McGraw-Hill; 2012. Chapter 261.Google Scholar
  10. 10.
    Lee GY, Cho S. Spinal anesthesia for cesarean section in a patient with systemic sclerosis associated interstitial lung disease: a case report. Kor J Anesthesiol. 2016;69(4):406–8.CrossRefGoogle Scholar
  11. 11.
    Lirk P, Kleber N, Mitterschiffthaler G, Keller C, Benzer A, Putz G. Pulmonary effects of bupivacaine, ropivacaine, and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery: a randomised controlled study. Int J Obstet Anesth. 2010;19(3):287–92.CrossRefGoogle Scholar
  12. 12.
    Moaveni D, Cohn J, Brodt J, Hoctor K, Ranasinghe J. Scleroderma and pulmonary hypertension complicating two pregnancies: use of neuraxial anesthesia, general anesthesia, epoprostenol and a multidisciplinary approach for cesarean delivery. Int J Obstet Anesth. 2015;24(4):375–82.CrossRefGoogle Scholar
  13. 13.
    Patel EM, Swamy GK, Heine RP, Kuller JA, James AH, Grotegut CA. Medical and obstetric complications among pregnant women with cystic fibrosis. Am J Obstet Gynecol. 2015;212(1):98.e1–9.CrossRefGoogle Scholar
  14. 14.
    Raghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2006;174(7):810–6.CrossRefGoogle Scholar
  15. 15.
    Rush B, Wiskar K, Berger L, Griesdale D. The use of mechanical ventilation in patients with idiopathic pulmonary fibrosis in the United States: a nationwide retrospective cohort analysis. Respir Med. 2016;111:72–6.CrossRefGoogle Scholar
  16. 16.
    Sugino S, Bortz BJ, Vaida S, Karamchandani K, Janicki PK. Peripartum anesthetic management and genomic analysis of rare variants in a patient with familial pulmonary fibrosis. A A Case Rep. 2015;5(10):169–72.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyCedars-Sinai Medical CenterLos AngelesUSA
  2. 2.Department of AnesthesiologyCharles Drew University of Medicine and ScienceLos AngelesUSA
  3. 3.Department of Obstetric AnesthesiologyCharles Drew University of Medicine and ScienceLos AngelesUSA

Personalised recommendations