Document Detail


Passive leg raising predicts fluid responsiveness in the critically ill.
MedLine Citation:
PMID:  16540963     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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. DESIGN: Prospective study. SETTING: Medical intensive care unit of a university hospital. PATIENTS: We investigated 71 mechanically ventilated patients considered for volume expansion. Thirty-one patients had spontaneous breathing activity and/or arrhythmias. INTERVENTIONS: We assessed hemodynamic status at baseline, after PLR, and after volume expansion (500 mL NaCl 0.9% infusion over 10 mins). MEASUREMENTS AND MAIN RESULTS: 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 > or =15% after fluid infusion. A PLR increase of aortic blood flow > or =10% predicted fluid responsiveness with a sensitivity of 97% and a specificity of 94%. A PLR increase of pulse pressure > or =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 > or =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%). CONCLUSIONS: 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.
Authors:
Xavier Monnet; Mario Rienzo; David Osman; Nadia Anguel; Christian Richard; Michael R Pinsky; Jean-Louis Teboul
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  34     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-05-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1402-7     Citation Subset:  AIM; IM    
Affiliation:
Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris 11, Le Kremlin-Bicêtre, France.
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MeSH Terms
Descriptor/Qualifier:
Aorta / ultrasonography
Blood Flow Velocity / physiology*
Blood Pressure / physiology*
Critical Illness
Female
Fluid Therapy*
Hemodynamics / physiology
Humans
Leg / blood supply*
Linear Models
Male
Middle Aged
Patient Selection*
Posture
Prospective Studies
Respiration, Artificial
Sensitivity and Specificity
Ultrasonography, Doppler
Grant Support
ID/Acronym/Agency:
HL 073198/HL/NHLBI NIH HHS; HL 67181/HL/NHLBI NIH HHS
Comments/Corrections
Comment In:
Crit Care Med. 2006 May;34(5):1559-60   [PMID:  16633259 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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