Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness.
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.
Lakhal
Karim
K
Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Bichat-Claude Bernard, Assistance Publique des Hôpitaux de Paris, Paris, France. lakhal_karim@yahoo.fr
Ehrmann
Stephan
S
Runge
Isabelle
I
Benzekri-Lefèvre
Dalila
D
Legras
Annick
A
Dequin
Pierre François
PF
Mercier
Emmanuelle
E
Wolff
Michel
M
Régnier
Bernard
B
Boulain
Thierry
T
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