Related Experiment Video
Updated: May 22, 2025
Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Fluid responsiveness of ambulatory paediatric patients with a Fontan circulation by passive leg raising
Lisette M Harteveld1,2, Nico A Blom1,2,3, J Gert van Dijk4
1The Centre for Congenital Heart Disease Amsterdam-Leiden, Leiden, The Netherlands.
Insights
Passive leg raising (PLR) is a tool to predict fluid responsiveness. In children with Fontan circulation, PLR elicits a hemodynamic response similar to healthy controls, suggesting its potential utility.
Area of Science:
- Pediatric Cardiology
- Hemodynamics
- Critical Care Medicine
Background:
- Passive leg raising (PLR) is utilized to predict fluid responsiveness in critically ill children.
- The Fontan circulation presents unique hemodynamic characteristics that may alter the response to PLR.
- Understanding this response is crucial for optimizing fluid management in these patients.
Purpose of the Study:
- To evaluate the hemodynamic response to passive leg raising in pediatric patients with Fontan circulation.
- To compare the response in Fontan patients to that of healthy pediatric controls.
- To determine if Fontan circulation influences the effectiveness of PLR as a fluid challenge predictor.
Main Methods:
- Non-invasive echocardiography was used to assess hemodynamic parameters, including velocity time integral (VTI) and blood pressure.
- Thirty-one pediatric patients with Fontan circulation and 35 healthy controls underwent PLR.
- Responders were defined as those with a ≥10.0% increase in VTI.
Main Results:
- No statistically significant difference in hemodynamic response to PLR was observed between Fontan patients and healthy controls (P = 0.22).
- The percentage of responders (38.7% in patients vs. 22.9% in controls) and the magnitude of VTI increase were similar between groups.
- Negative hemodynamic effects (VTI decrease ≤-10.0%) were also comparable between Fontan patients and controls.
Conclusions:
- Ambulatory pediatric patients with Fontan circulation exhibit a hemodynamic response to PLR comparable to healthy children.
- The findings suggest PLR may be a viable tool for assessing fluid responsiveness in this population.
- Further research is needed to investigate the response in critically ill pediatric patients with Fontan circulation.
Background:
Passive leg raising is used to predict who will benefit from fluid therapy in critically ill patients, including children. Patients with a Fontan circulation may have a different haemodynamic response to a fluid challenge by passive leg raising.
Methods:
The haemodynamic response of 31 paediatric patients with a Fontan circulation from the outpatient clinic (median age 14.0 years) and 35 healthy controls (median age 12.8 years) to passive leg raising was evaluated non-invasively by echocardiography for the assessment of, e.g., velocity time integral across the (neo)aortic valve, blood pressure measurements, and respiration. Participants were considered responders when the velocity time integral increased ≥ 10.0%.
Results:
Overall, patients and controls did not differ in the haemodynamic response. Twelve patients (38.7%) and 8 controls (22.9%) were responders, which was not statistically different (P = 0.22). Responders in the patient and control group also had a similar echo-estimated velocity time integral increase of + 18.9% and + 15.2%, respectively (P = 0.91). There was no difference in echo-estimated velocity time integral change between patient and control non-responders with a decrease of -1.4% and -6.4%, respectively (P = 0.70) and no difference in the amount of patients who were negatively affected by passive leg raising, ith a decrease of ≤-10.0% in 7 patients (22.6%) and 9 controls (25.7%)(P = 0.77).
Conclusion:
The haemodynamic response of ambulatory paediatric patients with a Fontan circulation to passive leg raising is like that of healthy controls. Patients who did not respond were similarly affected as healthy controls. Whether the haemodynamic response is different in critically ill patients warrants further investigation.
Trail Registration:
The Netherlands National Trial Register (NTR), Trial: NL6415; date of registration 20-07-2017; Trial information: https://www.trialregister.nl/trial/6415.
More Related Videos
Related Concept Videos
01:11Assessing Blood pressure in the Leg
Preparation:
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:04Venous Return
What is Venous Return?
Venous return refers to the rate at which blood flows back to the heart from the body's peripheral veins. It's an integral part of the circulatory system...