Intensive Care Medicine

, Volume 39, Issue 4, pp 593–600

Prediction of fluid responsiveness in severe preeclamptic patients with oliguria

  • Clément Brun
  • Laurent Zieleskiewicz
  • Julien Textoris
  • Laurent Muller
  • Jean-Pierre Bellefleur
  • François Antonini
  • Maxime Tourret
  • Denis Ortega
  • Armand Vellin
  • Jean-Yves Lefrant
  • Léon Boubli
  • Florence Bretelle
  • Claude Martin
  • Marc Leone
Original

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 

References

  1. 1.
    Duley L (2009) The global impact of pre-eclampsia and eclampsia. Semin Perinatol 33:130–137PubMedCrossRefGoogle Scholar
  2. 2.
    Sibai B, Dekker G, Kupferminc M (2005) Pre-eclampsia. Lancet 365:785–799PubMedGoogle Scholar
  3. 3.
    Young P, Johanson R (2001) Haemodynamic, invasive and echocardiographic monitoring in the hypertensive parturient. Best Pract Res Clin Obstet Gynaecol 15:605–622PubMedCrossRefGoogle Scholar
  4. 4.
    Barton JR, Sibai BM (2006) Life-threatening emergencies in preeclampsia-eclampsia. J Ky Med Assoc 104:410–418PubMedGoogle Scholar
  5. 5.
    Sciscione AC, Ivester T, Largoza M, Manley J, Shlossman P, Colmorgen GH (2003) Acute pulmonary edema in pregnancy. Obstet Gynecol 101:511–515PubMedCrossRefGoogle Scholar
  6. 6.
    Sibai BM, Mabie BC, Harvey CJ, Gonzalez AR (1987) Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases. Am J Obstet Gynecol 156:1174–1179PubMedGoogle Scholar
  7. 7.
    Societe francaise d’anesthesie et de reanimation. College national des gynecologues et obstetriciens francais. Societe francaise de medecine perinatale. Societe francaise de neonatalogie (2009) Multidisciplinary management of severe pre-eclampsia (PE). Experts guidelines 2008. Ann Fr Anesth Reanim 28:275–281CrossRefGoogle Scholar
  8. 8.
    Lowe SA, Brown MA, Dekker GA, Gatt S, McLintock CK, McMahon LP, Mangos G, Moore MP, Muller P, Paech M, Walters B (2009) Society of obstetric medicine of Australia and New Zealand: guidelines for the management of hypertensive disorders of pregnancy 2008. Aust N Z J Obstet Gynaecol 49:242–246PubMedCrossRefGoogle Scholar
  9. 9.
    Visintin C, Mugglestone MA, Almerie MQ, Nherera LM, James D, Walkinshaw S (2010) Management of hypertensive disorders during pregnancy: summary of NICE guidance. BMJ 341:c2207PubMedCrossRefGoogle Scholar
  10. 10.
    Clark SL, Greenspoon JS, Aldahl D, Phelan JP (1986) Severe preeclampsia with persistent oliguria: management of hemodynamic subsets. Am J Obstet Gynecol 154:490–494PubMedGoogle Scholar
  11. 11.
    Moulin B, Hertig A, Rondeau E (2010) Kidney and preeclampsia. Ann Fr Anesth Reanim 29:e83–e90PubMedCrossRefGoogle Scholar
  12. 12.
    Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008PubMedCrossRefGoogle Scholar
  13. 13.
    Monnet X, Teboul JL (2008) Passive leg raising. Intensive Care Med 34:659–663PubMedCrossRefGoogle Scholar
  14. 14.
    Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407PubMedCrossRefGoogle Scholar
  15. 15.
    Maizel J, Airapetian N, Lorne E, Tribouilloy C, Massy Z, Slama M (2007) Diagnosis of central hypovolemia by using passive leg raising. Intensive Care Med 33:1133–1138PubMedCrossRefGoogle Scholar
  16. 16.
    Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL (2007) Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 33:1125–1132PubMedCrossRefGoogle Scholar
  17. 17.
    Preau S, Saulnier F, Dewavrin F, Durocher A, Chagnon JL (2010) Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Crit Care Med 38:819–825PubMedCrossRefGoogle Scholar
  18. 18.
    Ryo E, Okai T, Kozuma S, Kobayashi K, Kikuchi A, Taketani Y (1996) Influence of compression of the inferior vena cava in the late second trimester on uterine and umbilical artery blood flow. Int J Gynaecol Obstet 55:213–218PubMedCrossRefGoogle Scholar
  19. 19.
    Ryo E, Unno N, Nagasaka T, Taketani Y (2004) Changes in the size of maternal inferior vena cava during pregnancy. J Perinatol Med 32:327–331CrossRefGoogle Scholar
  20. 20.
    Al-Khan A, Shah M, Altabban M, Kaul S, Dyer KY, Alvarez M (2011) Measurement of intraabdominal pressure in pregnant women at term. J Reprod Med 56:53–57PubMedGoogle Scholar
  21. 21.
    Axler O, Megarbane B, Lentschener C, Fernandez H (2003) Comparison of cardiac output measured with echocardiographic volumes and aortic Doppler methods during mechanical ventilation. Intensive Care Med 29:208–217PubMedGoogle Scholar
  22. 22.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108PubMedCrossRefGoogle Scholar
  23. 23.
    McGowan JH, Cleland JG (2003) Reliability of reporting left ventricular systolic function by echocardiography: a systematic review of 3 methods. Am Heart J 146:388–397PubMedCrossRefGoogle Scholar
  24. 24.
    Feissel M, Michard F, Faller JP, Teboul JL (2004) The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 30:1834–1837PubMedCrossRefGoogle Scholar
  25. 25.
    Robin X, Turck N, Hainard A, Tiberti N, Lisacek F, Sanchez JC (2011) pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinform 12:77CrossRefGoogle Scholar
  26. 26.
    Gaber LW, Spargo BH, Lindheimer MD (1994) Renal pathology in pre-eclampsia. Baillieres Clin Obstet Gynaecol 8:443–468PubMedCrossRefGoogle Scholar
  27. 27.
    Coudray A, Romand JA, Treggiari M, Bendjelid K (2005) Fluid responsiveness in spontaneously breathing patients: a review of indexes used in intensive care. Crit Care Med 33:2757–2762PubMedCrossRefGoogle Scholar
  28. 28.
    Sarnoff SJ, Berglund E (1954) Ventricular function. Starling’s law of the heart studied by means of simultaneous right and left ventricular function curves in the dog. Circulation 9:706–718PubMedCrossRefGoogle Scholar
  29. 29.
    Mahjoub Y, Touzeau J, Airapetian N, Lorne E, Hijazi M, Zogheib E, Tinturier F, Slama M, Dupont H (2010) The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med 38:1824–1829PubMedCrossRefGoogle Scholar
  30. 30.
    Lakhal K, Ehrmann S, Runge I, Benzekri-Lefèvre D, Legras A, Dequin PF, Mercier E, Wolff M, Régnier B, Boulain T (2010) Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness. Intensive Care Med 36:940–948PubMedCrossRefGoogle Scholar
  31. 31.
    Jabot J, Teboul JL, Richard C, Monnet X (2009) Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med 35:85–90PubMedCrossRefGoogle Scholar
  32. 32.
    Kircher BJ, Himelman RB, Schiller NB (1990) Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol 66:493–496PubMedCrossRefGoogle Scholar
  33. 33.
    Pierrakos C, Velissaris D, Scolletta S, Heenen S, De Backer D, Vincent JL (2012) Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock? Intensive Care Med 38:422–428PubMedCrossRefGoogle Scholar
  34. 34.
    Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, Bello G, Maviglia R, Antonelli M (2010) Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med 36:1475–1483PubMedCrossRefGoogle Scholar
  35. 35.
    Shankar H, Pagel PS (2011) Potential adverse ultrasound-related biological effects: a critical review. Anesthesiology 115:1109–1124PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Clément Brun
    • 1
  • Laurent Zieleskiewicz
    • 1
  • Julien Textoris
    • 1
  • Laurent Muller
    • 3
  • Jean-Pierre Bellefleur
    • 1
  • François Antonini
    • 1
  • Maxime Tourret
    • 1
  • Denis Ortega
    • 1
  • Armand Vellin
    • 1
  • Jean-Yves Lefrant
    • 3
  • Léon Boubli
    • 2
  • Florence Bretelle
    • 2
  • Claude Martin
    • 1
  • Marc Leone
    • 1
  1. 1.Service d’anesthésie et de réanimation, Hôpital NordAix Marseille UniversityMarseille cedex 20France
  2. 2.Service de gynécologie et d’obstétrique, Hôpital NordAix Marseille UniversityMarseilleFrance
  3. 3.Division Anesthésie Réanimation Douleur UrgencesGroupe Hospitalo-Universitaire Caremeau, Centre Hospitalier Universitaire de NîmesNîmesFrance

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