Critical Care and Shock

Strategic comparison of fluid management in pre-eclampsia before cesarean section between 1 ml/kg BW/hour of colloid plus 5 mg/hour of furosemide and 80 ml/hour of crystalloid: Hemodynamic optimalization and plasma albumin level improvements

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Objective: Pre-eclampsia is a major cause of mortality and morbidity in pregnant women and complicates 7-10% of pregnancies. The specific protocol for fluids administration in pre-eclampsia has not been used globally with potential generating pulmonary edema. The process of fluid shifting that occurs in the interstitial can be assessed objectively with a non-invasive monitor. The objective of this study was to determine the impact of colloid 1 ml/kg body weight (BW)/hour and furosemide 5 mg/hour administration compared with crystalloid 80 ml/hour administration as fluid therapy in pre-eclamptic patients related to hemodynamic profile and plasma albumin levels.

Design: An analytical experimental study with a randomized controlled clinical trial design.

Setting: A single tertiary care center in Tangerang, Indonesia.

Patients and participants: Forty patients diagnosed with pre-eclampsia who underwent elective or emergency cesarean section during August-December 2020.

Interventions: Patients were randomly divided into two groups and were given different pre-operative fluids. Group F received 1 ml/kg BW/hour of hydroxyethyl starch (HES) 6% with 5 mg/hour of furosemide and Group K received 80 ml/hour of crystalloid.

Measurements and results: Demographics, clinical characteristics, albumin level, and hemodynamic profile were evaluated. The reduction of albumin levels in Group F was significantly lower than in Group K. A significant difference was found in 24th-hour mean arterial pressure (MAP) (p=0.024), 15th-minute pulse rate (p=0.033), 24th-hour corrected flow time (FTc) (p=0.018), 15th-minute to 24th-hour thoracic fluid content (TFC) (p<0.05), and 24th-hour pleth variability index (PVI) (p=0.01). Giving 1 ml/kg BW of colloids and 5 mg/hour of furosemide could improve better hemodynamic profiles compared to 80 ml/hour of crystalloid based on evaluation of blood pressure, pulse rate, FTc, TFC, and PVI from non-invasive monitoring and also showed a slower reduction in plasma albumin level. This result might be due to the mechanism of fluid shifting from interstitial to plasma. However, the adverse events of hypotension still need to be cautiously monitored.

Conclusion: Colloid and furosemide administration affect improvements of hemodynamic profile parameters and plasma albumin levels in parturients with pre-eclampsia.