Implications of Continuous Noninvasive Finger Cuff Arterial Pressure Device Use during Cesarean Delivery for Goal-Directed Fluid Therapy Preload Optimization: A Randomized Controlled Trial

Shan-Han Yang, Yi-Shiuan Lin, Chien-Nan Lee, Ya-Jung Cheng, Ying-Hsi Chen, Hsin-Chan Chiu, Chun-Yu Wu, Shan-Han Yang, Yi-Shiuan Lin, Chien-Nan Lee, Ya-Jung Cheng, Ying-Hsi Chen, Hsin-Chan Chiu, Chun-Yu Wu

Abstract

Background: Although fixed-volume conventional fluid preloading protocol fails to attenuate postspinal hypotension during cesarean delivery, the effect of goal-directed fluid therapy (GDFT) remains less explored. Continuous noninvasive finger cuff arterial pressure monitoring using devices such as the ClearSight System can provide the noninvasive stroke volume value, enabling clinicians to perform GDFT before spinal anesthesia; however, the efficacy of GDFT requires further elucidation.

Method: In total, 71 consecutive full-term pregnant women were randomly divided into a control group (n = 34) and a GDFT group (n = 37). Before spinal anesthesia, the control group received a fixed dose (1000 mL) of crystalloid fluid, but the GDFT group received repeated 3 mL/kg body weight of crystalloid fluid challenges within 3 minutes with a 1-minute interval between each fluid challenge based on the stroke volume incremental changes obtained using the ClearSight System (targeting a stroke volume increase of ≥5% after a fluid challenge). The primary outcome was the incidence of postspinal hypotension. The secondary outcomes were total fluid volume, vasopressor dosage, hemodynamic parameter changes, maternal adverse effects, and neonatal profiles.

Result: Women in the GDFT group received more fluid than did those in the control group (1132 ± 108 vs. 1247 ± 202 mL; p = 0.0044), but the incidence of postspinal hypotension (79.4% vs. 73.0%,; p = 0.5864) and norepinephrine dose (12.5 ± 10.6 vs. 15.1 ± 12.8 mcg, respectively; p = 0.3512) was comparable between the two groups. Fewer women in the GDFT group experienced nausea (61.76% vs. 35.14%; p = 0.0332). Neonatal outcomes (Apgar score and umbilical blood analysis) were comparable and typical in both groups.

Conclusion: ClearSight-guided GDFT did not ameliorate postspinal hypotension but may reduce nausea. This trial is registered with NCT03013140.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Shan-Han Yang et al.

Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
Hemodynamic changes prior to neonatal delivery: (a) oscillometric systolic blood pressure changes; (b) heart rate changes; (c) stroke volume changes; (d) cardiac output changes. ∗ denotes a significant difference compared with data at T1 in the control group. # denotes a significant difference compared with data at T1 in the GDFT group.

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Source: PubMed

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