Diagnosis of central hypovolemia by using passive leg raising.
OBJECTIVE
Suspected central hypovolemia is a frequent clinical situation in hospitalized patients, and no simple bedside diagnostic test in spontaneously breathing patients is available. We tested the value of passive leg raising to predict hemodynamic improvement after fluid expansion in patients with suspected central hypovolemia.


METHODS
Prospective study in four intensive care units at the Amiens university hospital. Thirty-four spontaneously breathing patients with suspected hypovolemia were included and were classified as responders (cardiac output increased by 12% or more after fluid expansion) or nonresponders. Patients were analyzed in the supine position during 30 degrees leg raising and after fluid expansion.


RESULTS
Stroke volume and cardiac output determined by echocardiographic and Doppler techniques and heart rate and blood pressure were measured at baseline, during passive leg raising and after fluid expansion. An increase of cardiac output or stroke volume by 12% or more during passive leg raising was highly predictive of central hypovolemia (AUC 0.89+/-0.06, 95% CI 0.73-0.97 for cardiac output and AUC 0.9+/-0.06, 95% CI 0.74-0.97 for stroke volume). Sensitivity and specificity values were 63% and 89% for cardiac output and 69%, 89% for stroke volume respectively. A close correlation (r=0.75; p<0.0001) was observed between cardiac output changes during leg raising and changes in cardiac output after fluid expansion.


CONCLUSIONS
Bedside measurement of cardiac output or stroke volume by Doppler techniques during passive leg raising was predictive of a positive hemodynamic effect of fluid expansion in spontaneously breathing patients with suspected central hypovolemia.
Maizel
Julien
J
Unite de Reanimation Medicale, Service de Nephrologie, CHU Sud, 80054 cedex 1, Amiens, France.|INSERM, ERI 12, Amiens, France.
Airapetian
Norair
N
Unite de Reanimation Medicale, Service de Nephrologie, CHU Sud, 80054 cedex 1, Amiens, France.
Lorne
Emmanuel
E
INSERM, ERI 12, Amiens, France.
Tribouilloy
Christophe
C
INSERM, ERI 12, Amiens, France.
Massy
Ziad
Z
INSERM, ERI 12, Amiens, France.
Slama
Michel
M
Unite de Reanimation Medicale, Service de Nephrologie, CHU Sud, 80054 cedex 1, Amiens, France. slama.michel@chu-amiens.fr.|INSERM, ERI 12, Amiens, France. slama.michel@chu-amiens.fr.
D001794:Blood Pressure; D002302:Cardiac Output; D005260:Female; D005440:Fluid Therapy; D006339:Heart Rate; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis* / Q000628:therapy; D007866:Leg / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena; D013318:Stroke Volume; D016896:Treatment Outcome