Service d'anesthésie et de réanimation, Hôpital Nord, Aix Marseille University, 13915, Marseille cedex 20, France.
Intensive Care Med. 2013 Apr;39(4):593-600. doi: 10.1007/s00134-012-2770-2. Epub 2012 Dec 6.
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.
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.
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.
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.
由于严重子痫前期（SP）可能与急性肺水肿有关，因此需要准确预测液体反应性。被动抬腿（PLR）可预测液体反应性。PLR 在怀孕期间从未有过报道。我们的首要目标是确定出现少尿的 SP 患者在接受液体冲击后其每搏量增加的百分比。我们的第二个目标是评估 PLR 预测这些患者液体反应性的准确性。
前瞻性纳入 SP 患者。在发生少尿的亚组中，在基线时、PLR 期间和 15 分钟内输注 500ml 液体后进行经胸超声心动图检查。通过每搏量指数增加 15%来定义液体反应者。所有参数均进行 5 次连续测量，取平均值。
41 例 SP 患者中有 23 例（56%）出现少尿，其中 12 例（52%）对液体冲击有反应。在 PLR 期间，主动脉下血流速度时间积分的增加（ΔVTI）超过 12%可预测反应，其敏感性和特异性分别为 75[95%置信区间（CI）：0.42-0.95]和 100%（95%CI：0.72-1.00）。结合ΔVTI 和 VTI 的基线值的算法预测液体反应性的敏感性和特异性均为 100%（95%CI：0.74-1.00）和（95%CI：0.75-1.00）。尿量和下腔静脉直径呼吸变化不能预测液体反应性。
只有 52%的少尿患者是有反应者。PLR 可准确预测 SP 特定情况下的液体反应性。该无创测试应在未来的 SP 管理算法中进行测试。
