title: Pulse contour analysis to assess hemodynamic response to passive leg raising.
abstract: OBJECTIVE
  The authors evaluated the ability of 2 pulse contour cardiac output (CO) techniques to track CO changes during passive leg raising (PLR) to assess fluid loading responsiveness.
  
  
  METHODS
  A prospective study.
  
  
  METHODS
  An intensive care unit in a university hospital.
  
  
  METHODS
  Twenty mechanically ventilated postoperative cardiac surgery patients.
  
  
  METHODS
  Thirty-degree PLR.
  
  
  RESULTS
  The authors estimated CO by 3 techniques: thermodilution (COtd), arterial pulse power (Coli; LiDCO, London, UK), and pulse contour method (Com; FMS, Amsterdam, The Netherlands) based on uncalibrated Modelflow. The authors measured heart rate (HR), central venous pressure, arterial pulse pressure (PP), systolic pressure (SP), and mean arterial pressure (MAP). Stroke volume (SV), SP, PP, and SV variation (PPV and SVV, respectively) were calculated over 5 breaths. SVV was measured by both LiDCO (SVVli) and Modelflow (SVVm) devices. PLR-induced changes in COtd correlated with COli (p < 0.001) and COm (p < 0.001). Preload dependence was predicted with an area under the ROC curve of 0.968 for ΔCOm, 0.841 for ΔCOli, 0.825 for SVVm, 0.873 for SVVli, 0.808 for PPV, 0.778 for ΔSP, 0.714 for ΔPP, and 0.873 for ΔMAP.
  
  
  CONCLUSIONS
  Changes in COm, COli, SVV, and PPV track COtd changes during PLR with a high degree of accuracy in sedated, ventilated, postoperative cardiac surgery patients. Changes in pulse contour CO after PLR can be used to predict fluid loading responsiveness.
authors.affiliation: Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands. b.f.geerts@lumc.nl
authors.forename: Bart
authors.initials: B
authors.lastname: Geerts
authors.forename: Rob
authors.initials: R
authors.lastname: de Wilde
authors.forename: Leon
authors.initials: L
authors.lastname: Aarts
authors.forename: Jos
authors.initials: J
authors.lastname: Jansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D019540:Area Under Curve; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D003422:Critical Care; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007866:Leg / Q000098:blood supply* / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D012372:ROC Curve; D012039:Regional Blood Flow / Q000502:physiology; D012044:Regression Analysis; D012121:Respiration, Artificial; D013815:Thermodilution
chemical_list: D002316:Cardiotonic Agents