title: Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness.
abstract: OBJECTIVE
  Passive leg raising (PLR) is a maneuver performed to test the cardiac Frank-Starling mechanism. We assessed the influence of PLR-induced changes in preload on the performance of PLR-induced change in pulse pressure (Delta(PLR)PP) and cardiac output (Delta(PLR)CO) for fluid responsiveness prediction.
  
  
  METHODS
  Sedated, nonarrhythmic patients with persistent shock were included in this prospective multicenter study. Cardiac output and pulse pressure were measured at baseline (patient supine), during PLR (lower limbs lifted to 45 degrees) and after 500-ml volume expansion. Patients were classified as responders or not.
  
  
  RESULTS
  In the whole population (n = 102), the area under the receiver-operating characteristic curve (AUC) was 0.76 for Delta(PLR)PP and was higher for Delta(PLR)CO (0.89)(p < 0.05), but likelihood ratios were close to 1. In patients with a PLR-induced increase in central venous pressure (CVP) of at least 2 mmHg (n = 49), Delta(PLR)PP and Delta(PLR)CO disclosed higher AUCs than in the rest of the population (0.91 vs. 0.66 and 0.98 vs. 0.83; p < 0.05); positive/negative likelihood ratios were 9.3/0.14 (8% cutoff level) and 30/0.07 (7% cutoff level), respectively.
  
  
  CONCLUSIONS
  A PLR-induced change in CVP > or =2 mmHg was required to allow clinical usefulness of PLR-derived indices. In this situation, Delta(PLR)PP performed well for predicting fluid responsiveness in deeply sedated patients.
authors.affiliation: Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Paris, France. lakhal_karim@yahoo.fr
authors.forename: Karim
authors.initials: K
authors.lastname: Lakhal
authors.forename: Stephan
authors.initials: S
authors.lastname: Ehrmann
authors.forename: Isabelle
authors.initials: I
authors.lastname: Runge
authors.forename: Dalila
authors.initials: D
authors.lastname: Benzekri-Lefèvre
authors.forename: Annick
authors.initials: A
authors.lastname: Legras
authors.forename: Pierre François
authors.initials: PF
authors.lastname: Dequin
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mercier
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.forename: Bernard
authors.initials: B
authors.lastname: Régnier
authors.forename: Thierry
authors.initials: T
authors.lastname: Boulain
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002302:Cardiac Output; D002496:Central Venous Pressure / Q000502:physiology*; D005260:Female; D005602:France; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis; D007866:Leg; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies