The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension.
OBJECTIVE
The passive leg-raising maneuver is a reversible fluid-loading procedure used to predict fluid responsiveness in mechanically ventilated patients. The aim of the present study was to determine whether intra-abdominal hypertension (which impairs venous return) reduces the ability of passive leg raising to detect fluid responsiveness in critically ill ventilated patients.


METHODS
A prospective study.


METHODS
The medical and surgical intensive care unit of a university medical center.


METHODS
Forty-one mechanically ventilated patients with a pulse pressure variation of >12%.


METHODS
Stroke volume was continuously monitored by esophageal Doppler. Intra-abdominal pressure was measured via bladder pressure. After a passive leg-raising maneuver and a return to baseline, fluid loading with 500 mL of saline was performed. Hemodynamic parameters were recorded at each step. Nonresponders to volume loading were not analyzed (10 patients). Thirty-one patients were classified into two groups according to their response to passive leg raising: responders to passive leg raising (at least a 12% increase in stroke volume) and nonresponders to passive leg raising.


RESULTS
Sixteen patients (52%) were responders to passive leg raising, and 15 (48%) were nonresponders to passive leg raising (i.e., false negatives). At baseline, the median intra-abdominal pressure was significantly higher in the nonresponders to passive leg raising than in the responders to passive leg raising (20 [6.5] vs. 11.5 [5.5], respectively; p < .0001). The area under the receiver-operating characteristic curve was 0.969 +/- 0.033. An intra-abdominal pressure cutoff value of 16 mm Hg discriminated between responders to passive leg raising and nonresponders to passive leg raising with a sensitivity of 100% (confidence interval, 78-100) and a specificity of 87.5% (confidence interval, 61.6-98.1). An intra-abdominal pressure of > or =16 mm Hg was the only independent predictor of nonresponse to passive leg raising in a multivariate analysis (odds ratio, 2.6 [confidence interval, 1.1-6.6]; p = .04).


CONCLUSIONS
An intra-abdominal pressure of > or =16 mm Hg seems to be responsible for false negatives to passive leg raising. Hence, the intra-abdominal pressure should be measured in critically ill ventilated patients, especially before performing passive leg raising.
Mahjoub
Yazine
Y
Medical and Surgical Intensive Care Unit, Department of Anesthesia and Intensive Care, Amiens University Medical Center, Amiens, France. mahjoub.yazine@chu-amiens.fr
Touzeau
Jérémie
J
Airapetian
Norair
N
Lorne
Emmanuel
E
Hijazi
Mustapha
M
Zogheib
Elie
E
Tinturier
François
F
Slama
Michel
M
Dupont
Hervé
H
D000005:Abdomen; D003161:Compartment Syndromes / Q000503:physiopathology*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D007866:Leg / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome