Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity.
OBJECTIVE
In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsiveness is a difficult challenge since the respiratory variation in arterial pressure cannot be used. Our objective was to test whether volume responsiveness can be predicted by the response of stroke volume measured with transthoracic echocardiography to passive leg raising in patients with spontaneous breathing activity. We also examined whether common echocardiographic indices of cardiac filling status are valuable to predict volume responsiveness in this category of patients.


METHODS
Prospective study in the medical intensive care unit of a university hospital.


METHODS
24 patients with spontaneously breathing activity considered for volume expansion.


METHODS
We measured the response of the echocardiographic stroke volume to passive leg raising and to saline infusion (500 ml over 15 min). The left ventricular end-diastolic area and the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/Ea) were also measured before and after saline infusion.


RESULTS
A passive leg raising induced increase in stroke volume of 12.5% or more predicted an increase in stroke volume of 15% or more after volume expansion with a sensitivity of 77% and a specificity of 100%. Neither left ventricular end-diastolic area nor E/Ea predicted volume responsiveness.


CONCLUSIONS
In our critically ill patients with spontaneous breathing activity the response of echocardiographic stroke volume to passive leg raising was a good predictor of volume responsiveness. On the other hand, the common echocardiographic markers of cardiac filling status were not valuable for this purpose.
Lamia
Bouchra
B
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Ochagavia
Ana
A
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Monnet
Xavier
X
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Chemla
Denis
D
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.|Service d'Explorations Fonctionnelles, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Richard
Christian
C
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Teboul
Jean-Louis
JL
Service de Réanimation Médicale, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris Sud, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. jean-louis.teboul@bct.aphp.fr.
D000368:Aged; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007866:Leg / Q000502:physiology; D008297:Male; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena; D012680:Sensitivity and Specificity; D013318:Stroke Volume