| Passive leg raising predicts fluid responsiveness in the critically ill. | |
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MedLine Citation:
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PMID: 16540963 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Xavier Monnet; Mario Rienzo; David Osman; Nadia Anguel; Christian Richard; Michael R Pinsky; Jean-Louis Teboul |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Critical care medicine Volume: 34 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2006 May |
Date Detail:
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Created Date: 2006-04-24 Completed Date: 2006-05-17 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 1402-7 Citation Subset: AIM; IM |
Affiliation:
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Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris 11, Le Kremlin-Bicêtre, France. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aorta
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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:
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HL 073198/HL/NHLBI NIH HHS; HL 67181/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2006 May;34(5):1559-60
[PMID:
16633259
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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