| The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. | |
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MedLine Citation:
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PMID: 20639753 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: The passive leg-raising maneuver is a reversible fluid-loading procedure used to predict fluid responsiveness in mechanically ventilated patients. The aim of the present study was to determine whether intra-abdominal hypertension (which impairs venous return) reduces the ability of passive leg raising to detect fluid responsiveness in critically ill ventilated patients. DESIGN: A prospective study. SETTING: The medical and surgical intensive care unit of a university medical center. PATIENTS: Forty-one mechanically ventilated patients with a pulse pressure variation of >12%. INTERVENTIONS: Stroke volume was continuously monitored by esophageal Doppler. Intra-abdominal pressure was measured via bladder pressure. After a passive leg-raising maneuver and a return to baseline, fluid loading with 500 mL of saline was performed. Hemodynamic parameters were recorded at each step. Nonresponders to volume loading were not analyzed (10 patients). Thirty-one patients were classified into two groups according to their response to passive leg raising: responders to passive leg raising (at least a 12% increase in stroke volume) and nonresponders to passive leg raising. MEASUREMENTS AND MAIN RESULTS: Sixteen patients (52%) were responders to passive leg raising, and 15 (48%) were nonresponders to passive leg raising (i.e., false negatives). At baseline, the median intra-abdominal pressure was significantly higher in the nonresponders to passive leg raising than in the responders to passive leg raising (20 [6.5] vs. 11.5 [5.5], respectively; p < .0001). The area under the receiver-operating characteristic curve was 0.969 +/- 0.033. An intra-abdominal pressure cutoff value of 16 mm Hg discriminated between responders to passive leg raising and nonresponders to passive leg raising with a sensitivity of 100% (confidence interval, 78-100) and a specificity of 87.5% (confidence interval, 61.6-98.1). An intra-abdominal pressure of > or =16 mm Hg was the only independent predictor of nonresponse to passive leg raising in a multivariate analysis (odds ratio, 2.6 [confidence interval, 1.1-6.6]; p = .04). CONCLUSIONS: An intra-abdominal pressure of > or =16 mm Hg seems to be responsible for false negatives to passive leg raising. Hence, the intra-abdominal pressure should be measured in critically ill ventilated patients, especially before performing passive leg raising. |
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Authors:
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Yazine Mahjoub; Jérémie Touzeau; Norair Airapetian; Emmanuel Lorne; Mustapha Hijazi; Elie Zogheib; François Tinturier; Michel Slama; Hervé Dupont |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 38 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-20 Completed Date: 2010-09-27 Revised Date: - |
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: 1824-9 Citation Subset: AIM; IM |
Affiliation:
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Medical and Surgical Intensive Care Unit, Department of Anesthesia and Intensive Care, Amiens University Medical Center, Amiens, France. mahjoub.yazine@chu-amiens.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Abdomen* Compartment Syndromes / physiopathology* Female Fluid Therapy* Humans Hypertension / complications Leg / physiopathology* Male Middle Aged Predictive Value of Tests Pressure Prospective Studies Respiration, Artificial Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2010 Sep;38(9):1912-5
[PMID:
20724891
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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