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Accuracy of Passive Leg Raising Test in Prediction of Fluid Responsiveness in Children
Ahmed A El-Nawawy1, Passant M Farghaly1, Hadir M Hassouna1
1Pediatric Department (PICU), Faculty of Medicine, Alexandria University, Egypt.
Insights
The passive leg raising (PLR) test accurately identifies non-responders in critically ill children under five. While reliable for detecting non-responders, it cannot definitively identify all fluid responders.
Area of Science:
- Pediatric critical care medicine
- Hemodynamic monitoring
Background:
- Fluid responsiveness assessment is crucial in critically ill children.
- Accurate prediction of fluid responsiveness aids in optimizing hemodynamic management.
Purpose of the Study:
- To evaluate the accuracy of the passive leg raising (PLR) test in predicting fluid responsiveness in critically ill children younger than 5 years.
- To determine the sensitivity and specificity of PLR in this pediatric population.
Main Methods:
- Prospective observational study in a pediatric intensive care unit.
- Hemodynamic parameters, including stroke volume (SV) and cardiac index (CI), were measured using bedside transthoracic echocardiography.
- Changes in SV (delta SV) and CI were assessed after PLR and fluid challenge.
Main Results:
- A 10% increase in delta SV after PLR demonstrated excellent discrimination of fluid responsiveness (AUC 0.81, 100% specificity).
- An 8.7% increase in CI after PLR also significantly discriminated fluid responsiveness (AUC 0.7, 91.67% specificity).
Conclusions:
- Passive leg raising is a reliable test for identifying non-responders in critically ill children under five.
- The test is most effective when performed correctly with echocardiography to measure its transient effects.
Aim:
To assess the accuracy of the passive leg raising (PLR) test to anticipate fluid responsiveness in critically ill children under age of 5 years.
Materials And Methods:
A prospective observational study was conducted, in a university hospital pediatric intensive care unit from June 1, 2017, to January 30, 2018. Hemodynamic parameters including stroke volume using bedside transthoracic echocardiography were assessed at baseline I (45° semi-recumbent position), after PLR, at baseline II, and following fluid challenge. Changes in the stroke volume (delta SV) and in the cardiac index (CI) were recorded after PLR and fluid challenge.
Findings:
Delta SV of 10% after PLR was an excellent discriminator of the fluid responsiveness with an area under ROC (AUC) of 0.81 (95% CI 0.68-0.9) with a sensitivity of 65.38% and a specificity of 100%. The change in CI of 8.7% after PLR was a significant discriminator of fluid responsiveness with an AUC of 0.7 (95% CI 0.56-0.81) with 57.78% sensitivity and 91.67% specificity.
Conclusion:
Passive leg raising can identify nonresponders among seriously ill children under the age of 5 years but it cannot identify all responders with certainty.
Clinical Significance:
Passive leg raising is reliable test in under 5 year-old-children if performed appropriately using bedside echocardiography for the measurement of its transient effect.
How To Cite This Article:
El-Nawawy AA, Farghaly PM, Hassouna HM, Accuracy of Passive Leg Raising Test in Prediction of Fluid Responsiveness in Children. Int J Clin Pediatr Dent 2020;24(5):344-349.
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