Passive leg raising predicts fluid responsiveness in the critically ill*
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- 1 May 2006
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 34 (5), 1402-1407
- https://doi.org/10.1097/01.ccm.0000215453.11735.06
Abstract
Passive leg raising (PLR) represents a “self-volume challenge” that could predict fluid response and might be useful when the respiratory variation of stroke volume cannot be used for that purpose. We hypothesized that the hemodynamic response to PLR predicts fluid responsiveness in mechanically ventilated patients. Prospective study. Medical intensive care unit of a university hospital. We investigated 71 mechanically ventilated patients considered for volume expansion. Thirty-one patients had spontaneous breathing activity and/or arrhythmias. We assessed hemodynamic status at baseline, after PLR, and after volume expansion (500 mL NaCl 0.9% infusion over 10 mins). We recorded aortic blood flow using esophageal Doppler and arterial pulse pressure. We calculated the respiratory variation of pulse pressure in patients without arrhythmias. In 37 patients (responders), aortic blood flow increased by ≥15% after fluid infusion. A PLR increase of aortic blood flow ≥10% predicted fluid responsiveness with a sensitivity of 97% and a specificity of 94%. A PLR increase of pulse pressure ≥12% predicted volume responsiveness with significantly lower sensitivity (60%) and specificity (85%). In 30 patients without arrhythmias or spontaneous breathing, a respiratory variation in pulse pressure ≥12% was of similar predictive value as was PLR increases in aortic blood flow (sensitivity of 88% and specificity of 93%). In patients with spontaneous breathing activity, the specificity of respiratory variations in pulse pressure was poor (46%). The changes in aortic blood flow induced by PLR predict preload responsiveness in ventilated patients, whereas with arrhythmias and spontaneous breathing activity, respiratory variations of arterial pulse pressure poorly predict preload responsiveness.Keywords
This publication has 24 references indexed in Scilit:
- Clinical Usefulness of Respiratory Variations in Arterial PressureAmerican Journal of Respiratory and Critical Care Medicine, 2004
- Predicting Fluid Responsiveness in ICU PatientsChest, 2002
- Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill PatientsChest, 2002
- The important role of left ventricular relaxation and left atrial pressure in the left ventricular filling velocity profileAmerican Heart Journal, 1989
- Changes in cardiac output after acute blood loss and position change in manCritical Care Medicine, 1989
- Trendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery diseaseCritical Care Medicine, 1989
- Nitroglycerin-induced decrease of carbon monoxide diffusion capacity in acute myocardial infarction reversed by elevating legsCritical Care Medicine, 1987
- Passive Leg Raising Does Not Produce a Significant or Sustained Autotransfusion EffectJournal Of Trauma-Injury Infection and Critical Care, 1982
- Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man.Circulation, 1981
- THE CIRCULATORY RESPONSE TO A STANDARD POSTURAL CHANGE IN ISCHAeMIC HEART DISEASEHeart, 1965