Bedside Echocardiography and Passive Leg Raise as a Measure of Volume Responsiveness in the Emergency Department

Abstract

Objectives The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness. Methods This work was a prospective observational study of patients with end‐stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded. Results Fifty‐four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55–29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98–30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92–31.69 cm), and it increased to 34.91 cm (95% CI, 33.11–36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%–3.55%) in the predialysis group and 15.05% (95% CI, 12.76%–17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%–15.49%) and 16.84% (95% CI, 13.47%–20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%–18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%–18.35%). Conclusions The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.

Ultrasound in postresuscitation care: a narrative review

“…Heart LVEDA <10 cm 2 indicates hypovolemia and ≥ 20 cm 2 suggests hypervolemia [24,26]. LVOT VTI > 12-15% increase after passive leg raising to predict fluid responsiveness [31].…”

“…1). A more than 12–15% increase in VTI after the PLR test has demonstrated favorable accuracy in predicting fluid responsiveness [31]. Using pre-/postassessments of LVOT VTI paired with the PLR test is well correlated with the volume status and would be suitable to predict volume responsiveness in emergency settings [31] (Table 2).…”

Changes of cardiac output and velocity time integral in blood return at the end of renal replacement therapy predict fluid responsiveness in critically Ill patients with acute circulatory failure

“…Transthoracic echocardiography was performed excellently in estimating cardiac out based on LVOT-VTI compared with pulmonary artery catheter [ 24 , 25 ]. Additionally, LVOT-VTI combined with PLRT could screen volume responsiveness from end-stage renal disease patients after hemodialysis with the mean VTI increasing from 30.31 cm to 34.91 cm and the mean ΔVTI between 12.64% and 16.84% [ 26 ]. And LVOT-VTI is reliable and repeatable in distinguishing fluid responders from all shock patients.…”

Feasibility of Very Early Identification of Cardiogenic Shock by Semi-automated Ultrasound Exam in the Emergency Department

“…Prior studies have established that using POCUS in ED patients with hypotension decreases diagnostic uncertainty, decreases time to disposition, and reduces time to critical interventions [23][24][25][26][27][28][29]. Obtaining more advanced measurements, such as LVOT VTI, requires more skill but provides significant information on the etiology of hypotension and volume responsiveness [30][31][32][33]. Improved machine learning and automation of hemodynamic measurements have the potential to reduce error, increase reproducibility, and simplify ongoing assessment.…”