Passive leg raising for predicting fluid responsiveness: importance of the postural change.
OBJECTIVE
For predicting fluid responsiveness by passive leg raising (PLR), the lower limbs can be elevated at 45 degrees either from the 45 degrees semi-recumbent position (PLR(SEMIREC)) or from the supine position (PLR(SUPINE)). PLR(SUPINE) could have a lower hemodynamic impact than PLR(SEMIREC) since it should not recruit the splanchnic venous reservoir.


METHODS
Prospective study


METHODS
A 24-bed medical intensive care unit.


METHODS
A total of 35 patients with circulatory failure who responded to an initial PLR(SEMIREC) by an increase in cardiac index >/= 10%.


METHODS
PLR(SEMIREC), a transfer from the semi-recumbent to the supine position and PLR(SUPINE) were performed in all patients in a random order before fluid expansion (500 mL saline).


RESULTS
PLR(SEMIREC), supine transfer and PLR(SUPINE) significantly increased the pulse-contour derived cardiac index (PiCCOplus) by 22 (17-28)%, 9 (5-15)% and 10 (7-14)% (P < 0.05 vs. PLR(SEMIREC) for the latter two), respectively. These maneuvers significantly increased the right ventricular end-diastolic area (echocardiography) by 20 (14-29)%, 9 (5-16)% and 10 (5-16)% (P < 0.05 vs. PLR(SEMIREC) for the latter two) and the central venous pressure by 33 (22-50)%, 15 (10-20)% and 20 (15-29)% (P < 0.05 vs. PLR(SEMIREC) for the latter two), respectively. Volume expansion significantly increased cardiac index by 27 (21-38)% and all patients were responders to volume expansion. If an increase in cardiac index >/= 10% is considered as a positive response to PLR(SUPINE), 15 (43%) patients would have been unduly predicted as non-responders to fluid administration by PLR(SUPINE).


CONCLUSIONS
PLR(SEMIREC) induces larger increase in cardiac preload than PLR(SUPINE) and may be preferred for predicting fluid responsiveness.
Jabot
Julien
J
Service de Réanimation Médicale, AP-HP, Hôpital de Bicêtre, Centre Hospitalier Universitaire de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
Teboul
Jean-Louis
JL
Richard
Christian
C
Monnet
Xavier
X
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis* / Q000209:etiology; D007362:Intensive Care Units; D035002:Lower Extremity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011187:Posture; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications
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