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Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Passive leg raising predicts fluid responsiveness in the critically ill
Xavier Monnet1, Mario Rienzo, David Osman
1Service de réanimation médicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris 11, Le Kremlin-Bicêtre, France.
Critical Care Medicine
|March 17, 2006
Summary
Passive leg raising (PLR) accurately predicts fluid responsiveness in mechanically ventilated patients. This method is more reliable than pulse pressure variations, especially in patients with arrhythmias or spontaneous breathing.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Fluid Responsiveness Monitoring
Background:
- Assessing fluid responsiveness is crucial in mechanically ventilated patients.
- Traditional methods like respiratory variation of stroke volume may be limited.
- Passive leg raising (PLR) offers a non-invasive volume challenge to predict fluid response.
Purpose of the Study:
- To evaluate the hypothesis that hemodynamic response to PLR predicts fluid responsiveness.
- To compare the predictive value of PLR with respiratory variations in pulse pressure.
Main Methods:
- Prospective study in a medical intensive care unit.
- Investigated 71 mechanically ventilated patients.
- Assessed hemodynamic status (aortic blood flow, pulse pressure) at baseline, after PLR, and after fluid expansion.
Main Results:
- A PLR-induced increase in aortic blood flow (≥10%) predicted fluid responsiveness with 97% sensitivity and 94% specificity.
- PLR was more accurate than pulse pressure variations (≥12%), especially in patients with arrhythmias or spontaneous breathing.
- Respiratory variation in pulse pressure had poor specificity in patients with spontaneous breathing (46%).
Conclusions:
- Hemodynamic changes induced by PLR reliably predict preload responsiveness in ventilated patients.
- PLR is a valuable tool for fluid management decisions.
- Respiratory variations of arterial pulse pressure are less reliable in complex patient populations.
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