title: Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis.
abstract: OBJECTIVE
  Rapid fluid loading is standard treatment for hypovolemia. Because volume expansion does not always improve hemodynamic status, predictive parameters of fluid responsiveness are needed. Passive leg raising is a reversible maneuver that mimics rapid volume expansion. Passive leg raising-induced changes in stroke volume and its surrogates are reliable predictive indices of volume expansion responsiveness for mechanically ventilated patients. We hypothesized that the hemodynamic response to passive leg raising indicates fluid responsiveness in nonintubated patients without mechanical ventilation.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Intensive care unit of a general hospital.
  
  
  METHODS
  We investigated consecutive nonintubated patients, without mechanical ventilation, considered for volume expansion.
  
  
  METHODS
  We assessed hemodynamic status at baseline, after passive leg raising, and after volume expansion (500 mL 6% hydroxyethyl starch infusion over 30 mins).
  
  
  RESULTS
  We measured stroke volume using transthoracic echocardiography, radial pulse pressure using an arterial catheter, and peak velocity of femoral artery flow using continuous Doppler. We calculated changes in stroke volume, pulse pressure, and velocity of femoral artery flow induced by passive leg raising (respectively, Deltastroke volume, Deltapulse pressure, and Deltavelocity of femoral artery flow). Among 34 patients included in this study, 14 had a stroke volume increase of >or=15% after volume expansion (responders). All patients included in the study had severe sepsis (n = 28; 82%) or acute pancreatitis (n = 6; 18%). The Deltastroke volume >or=10% predicted fluid responsiveness with sensitivity of 86% and specificity of 90%. The Deltapulse pressure >or=9% predicted fluid responsiveness with sensitivity of 79% and specificity of 85%. The Deltavelocity of femoral artery flow >or=8% predicted fluid responsiveness with sensitivity of 86% and specificity of 80%.
  
  
  CONCLUSIONS
  Changes in stroke volume, radial pulse pressure, and peak velocity of femoral artery flow induced by passive leg raising are accurate and interchangeable indices for predicting fluid responsiveness in nonintubated patients with severe sepsis or acute pancreatitis.
authors.affiliation: Service de Réanimation polyvalente, Centre Hospitalier Jean Bernard, Valenciennes, France. seb.preau@gmail.com
authors.forename: Sébastien
authors.initials: S
authors.lastname: Préau
authors.forename: Fabienne
authors.initials: F
authors.lastname: Saulnier
authors.forename: Florent
authors.initials: F
authors.lastname: Dewavrin
authors.forename: Alain
authors.initials: A
authors.lastname: Durocher
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Chagnon
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D003422:Critical Care / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D020896:Hypovolemia / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D018805:Sepsis / Q000503:physiopathology* / Q000628:therapy*; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D006895:Hydroxyethyl Starch Derivatives