title: Prediction of fluid responsiveness in severe preeclamptic patients with oliguria.
abstract: OBJECTIVE
  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.
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Aix Marseille University, 13915, Marseille cedex 20, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Brun
authors.forename: Laurent
authors.initials: L
authors.lastname: Zieleskiewicz
authors.forename: Julien
authors.initials: J
authors.lastname: Textoris
authors.forename: Laurent
authors.initials: L
authors.lastname: Muller
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bellefleur
authors.forename: François
authors.initials: F
authors.lastname: Antonini
authors.forename: Maxime
authors.initials: M
authors.lastname: Tourret
authors.forename: Denis
authors.initials: D
authors.lastname: Ortega
authors.forename: Armand
authors.initials: A
authors.lastname: Vellin
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Lefrant
authors.forename: Léon
authors.initials: L
authors.lastname: Boubli
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.forename: Claude
authors.initials: C
authors.lastname: Martin
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
mesh_terms: D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods / Q000592:standards; D005602:France; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007866:Leg / Q000098:blood supply; D009846:Oliguria / Q000150:complications*; D011225:Pre-Eclampsia / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*; D055815:Young Adult