Severe preeclampsia with persistent oliguria: management of hemodynamic subsets

Nine patients with severe preeclampsia or eclampsia complicated by persistent oliguria failed to respond to fluid challenge and underwent pulmonary artery catheterization to guide further fluid and hemodynamic management. Three hemodynamic subsets of patients were defined. Patients in category I had low pulmonary capillary wedge pressure, hyperdynamic ventricular function, and moderate elevation of systemic vascular resistance. These patients responded to volume infusion with a decline in systemic vascular resistance, a rise in wedge pressure and cardiac output, resolution of oliguria, and no change in blood pressure. Patients in category II had normal or elevated pulmonary capillary wedge pressure and cardiac output and normal systemic vascular resistance; they responded to pharmacologic preload and/or afterload reduction. A single patient (category III) exhibited markedly elevated wedge pressure and systemic vascular resistance and depressed ventricular function. Oliguria in this patient responded to volume restriction and aggressive afterload reduction. Hemodynamic observations in patients in category II imply the presence of selective vasodilator responsive renal arteriospasm in some preeclamptic patients with oliguria.