Original

Intensive Care Medicine

, Volume 39, Issue 4, pp 593-600

First online:

Prediction of fluid responsiveness in severe preeclamptic patients with oliguria

  • Clément BrunAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Laurent ZieleskiewiczAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Julien TextorisAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Laurent MullerAffiliated withDivision Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de Nîmes
  • , Jean-Pierre BellefleurAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , François AntoniniAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Maxime TourretAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Denis OrtegaAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
  • , Armand VellinAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
    • , Jean-Yves LefrantAffiliated withDivision Anesthésie Réanimation Douleur Urgences, Groupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de Nîmes
    • , Léon BoubliAffiliated withService de gynécologie et d’obstétrique, Hôpital Nord, Aix Marseille University
    • , Florence BretelleAffiliated withService de gynécologie et d’obstétrique, Hôpital Nord, Aix Marseille University
    • , Claude MartinAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University
    • , Marc LeoneAffiliated withService d’anesthésie et de réanimation, Hôpital Nord, Aix Marseille University Email author 

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Abstract

Purpose

Because severe preeclampsia (SP) may be associated with acute pulmonary oedema, fluid responsiveness needs to be accurately predicted. Passive leg raising (PLR) predicts fluid responsiveness. PLR has never been reported during pregnancy. Our first aim was to determine the percentage of SP patients with oliguria increasing their stroke volume after fluid challenge. Our second aim was to assess the accuracy of PLR to predict fluid responsiveness in those patients.

Methods

Patients with SP were prospectively included in the study. In the subgroup developing oliguria, transthoracic echocardiography was performed at baseline, during PLR and after a 500 ml fluid infusion over 15 min. Fluid responders were defined by a 15 % increase of stroke volume index. Five consecutive measurements were averaged for all parameters.

Results

Twenty-three (56 %) out of 41 patients with SP developed oliguria, 12 (52 %) out of these 23 responded to fluid challenge. During PLR, an increase of the velocity time integral of subaortic blood flow (ΔVTI) above 12 % predicted the response with a sensitivity and specificity of 75 [95 % confident interval (CI): 0.42–0.95] and 100 % (95 % CI: 0.72–1.00), respectively. An algorithm combining ΔVTI and the baseline value of VTI predicted fluid responsiveness with a sensitivity and specificity of 100 % (95 % CI: 0.74–1.00) and (95 % CI: 0.75–1.00). Urine output and respiratory variations of inferior vena cava diameter did not predict fluid responsiveness.

Conclusions

Only 52 % of oliguric patients were responders. PLR accurately predicts fluid responsiveness in the specific setting of SP. This noninvasive test should be tested in future algorithms for the management of SP.

Keywords

Preeclampsia Fluid responsiveness Passive leg raising Echocardiography