Passive leg raising predicts fluid responsiveness in the critically ill.
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.


METHODS
Prospective study.


METHODS
Medical intensive care unit of a university hospital.


METHODS
We investigated 71 mechanically ventilated patients considered for volume expansion. Thirty-one patients had spontaneous breathing activity and/or arrhythmias.


METHODS
We assessed hemodynamic status at baseline, after PLR, and after volume expansion (500 mL NaCl 0.9% infusion over 10 mins).


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.
Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris 11, Le Kremlin-Bicêtre, France.
Xavier
X
Monnet
Mario
M
Rienzo
David
D
Osman
Nadia
N
Anguel
Christian
C
Richard
Michael R
MR
Pinsky
Jean-Louis
JL
Teboul
D001011:Aorta / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology*; D016638:Critical Illness; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007866:Leg / Q000098:blood supply*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011187:Posture; D011446:Prospective Studies; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler