Document Detail

Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness.
MedLine Citation:
PMID:  20111858     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Passive leg raising (PLR) is a maneuver performed to test the cardiac Frank-Starling mechanism. We assessed the influence of PLR-induced changes in preload on the performance of PLR-induced change in pulse pressure (Delta(PLR)PP) and cardiac output (Delta(PLR)CO) for fluid responsiveness prediction. METHODS: Sedated, nonarrhythmic patients with persistent shock were included in this prospective multicenter study. Cardiac output and pulse pressure were measured at baseline (patient supine), during PLR (lower limbs lifted to 45 degrees) and after 500-ml volume expansion. Patients were classified as responders or not. RESULTS: In the whole population (n = 102), the area under the receiver-operating characteristic curve (AUC) was 0.76 for Delta(PLR)PP and was higher for Delta(PLR)CO (0.89)(p < 0.05), but likelihood ratios were close to 1. In patients with a PLR-induced increase in central venous pressure (CVP) of at least 2 mmHg (n = 49), Delta(PLR)PP and Delta(PLR)CO disclosed higher AUCs than in the rest of the population (0.91 vs. 0.66 and 0.98 vs. 0.83; p < 0.05); positive/negative likelihood ratios were 9.3/0.14 (8% cutoff level) and 30/0.07 (7% cutoff level), respectively. CONCLUSIONS: A PLR-induced change in CVP > or =2 mmHg was required to allow clinical usefulness of PLR-derived indices. In this situation, Delta(PLR)PP performed well for predicting fluid responsiveness in deeply sedated patients.
Karim Lakhal; Stephan Ehrmann; Isabelle Runge; Dalila Benzekri-Lefèvre; Annick Legras; Pierre François Dequin; Emmanuelle Mercier; Michel Wolff; Bernard Régnier; Thierry Boulain
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2010-01-29
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-06     Completed Date:  2010-09-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  940-8     Citation Subset:  IM    
Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Paris, France.
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MeSH Terms
Blood Pressure / physiology*
Cardiac Output
Central Venous Pressure / physiology*
Hypovolemia / diagnosis
Middle Aged
Monitoring, Physiologic / methods
Posture / physiology*
Prospective Studies
Comment In:
Intensive Care Med. 2010 Aug;36(8):1445; author reply 446   [PMID:  20495783 ]
Intensive Care Med. 2010 Jun;36(6):912-4   [PMID:  20221747 ]

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