title: The passive leg raise test to predict fluid responsiveness in children--preliminary observations.
abstract: OBJECTIVE
  To assess whether the passive leg raising (PLR) test can predict fluid responsiveness in pediatric patients.
  
  
  METHODS
  This was a prospective observational study in a tertiary care pediatric center. Hemodynamic parameters including heart rate, stroke volume and cardiac output were assessed at baseline, after passive leg raising (PLR), at second baseline, and after volume loading (10 mL/kg normal saline in 10 min). Cutoff values of 7.5 and 10 % increase in cardiac index (CI) with passive leg raising were explored as predictors of volume loading response.
  
  
  RESULTS
  Overall, the changes in CI with passive leg raising varied widely and was a poor predictor of response to volume loading in children under 5 years of age. Of 40 patients, 23 had greater than 10 % increase in CI with PLR which predicted fluid responsiveness with a sensitivity of 94 % (95 % confidence interval 71,100) and specificity of 26 % (95 % confidence interval 10,48). Sensitivity was higher (100 % vs. 91 %) and specificity similar (27 % vs. 25 %) in predicting CI for those over 5 as compared to under 5 y, respectively. In patients over 5 y, simple linear regression revealed a positive correlation (R(2) = 21) while R(2) values were much lower (0-0.07) for those under 5 y.
  
  
  CONCLUSIONS
  Cardiac index changes after PLR varies widely in children and may be a poor predictor to volume loading in children under 5-y-old. However, in those over 5 y, PLR may be helpful in predicting fluid responsiveness in pediatric patients.
authors: Division of Pediatric Emergency Medicine and Critical Care Medicine, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, People's Republic of China.
authors: Guo-ping
authors: GP
authors: Lu
authors: Gangfeng
authors: G
authors: Yan
authors: Yang
authors: Y
authors: Chen
authors: Zhu-jin
authors: ZJ
authors: Lu
authors: Lin-en
authors: LE
authors: Zhang
authors: Niranjan
authors: N
authors: Kissoon
mesh_terms: D002302:Cardiac Output; D002648:Child; D002675:Child, Preschool; D003935:Diagnostic Techniques, Cardiovascular; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007194:India; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D018570:Risk Assessment / Q000379:methods; D012769:Shock / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy