title: Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies.
abstract: OBJECTIVE
  To systematically review the published evidence on the ability of passive leg raising-induced changes in cardiac output (PLR-cCO) and in arterial pulse pressure (PLR-cPP) to predict fluid responsiveness.
  
  
  METHODS
  MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were screened. Clinical trials on human adults published as full-text articles in indexed journals were included. Two authors independently used a standardized form to extract data about study characteristics and results. Study quality was assessed by using the QUADAS scale.
  
  
  RESULTS
  Nine articles including a total of 353 patients were included in the final analysis. Data are reported as point estimate (95% confidence intervals). The pooled sensitivity and specificity of PLR-cCO were 89.4% (84.1-93.4%) and 91.4% (85.9-95.2%) respectively. Diagnostic odds ratio was 89.0 (40.2-197.3). The pooled area under the receiver operating characteristics curve (AUC) was 0.95 (0.92-0.97). The pooled correlation coefficient r between baseline value of PLR-cCO and CO increase after fluid load was 0.81 (0.75-0.86). The pooled difference in mean PLR-cCO values between responders and non-responders was 17.7% (13.6-21.8%). No significant differences were identified between patients adapted to ventilator versus those with inspiratory efforts nor between patients in sinus rhythm versus those with arrhythmias. The pooled AUC for PLR-cPP was 0.76 (0.67-0.86) and was significantly lower than the AUC for PLR-cCO (p < 0.001). The pooled difference in mean PLR-cPP values between responders and non-responders was 10.3% (6.5-14.1%).
  
  
  CONCLUSIONS
  Passive leg raising-induced changes in cardiac output can reliably predict fluid responsiveness regardless of ventilation mode and cardiac rhythm. PLR-cCO has a significantly higher predictive value than PLR-cPP.
authors.affiliation: Department of Anesthesiology and Intensive Care, Intensive Care Unit, Catholic University School of Medicine, Agostino Gemelli Hospital, Rome, Italy. fabiocavallaro@fastwebnet.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Cavallaro
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandroni
authors.forename: Cristina
authors.initials: C
authors.lastname: Marano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.forename: Chiara
authors.initials: C
authors.lastname: De Waure
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bello
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maviglia
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001794:Blood Pressure; D002496:Central Venous Pressure; D016001:Confidence Intervals; D016638:Critical Illness / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000379:methods*; D016683:Supine Position; D016896:Treatment Outcome