Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness

Abstract

A PLR-induced change in CVP > or =2 mmHg was required to allow clinical usefulness of PLR-derived indices. In this situation, Delta(PLR)PP performed well for predicting fluid responsiveness in deeply sedated patients.

Passive leg raising: keep it easy!

“…Dear Editor, We read with interest the recently published article by Lakhal et al [1]. The authors confirmed that the passive leg raising (PLR) test was a good predictor of fluid responsiveness when its effects were assessed on cardiac output.…”

Prédiction de la réponse au remplissage vasculaire: que faire de tous ces indices proposés ?

“…Même lorsque les conditions optimales semblent requises, les modifications de précharge peuvent être insuffisantes. Lakhal et al [23] ont montré chez 110 patients que les performances du test étaient meilleures chez les patients présentant une augmentation de PVC d'au moins 2 mmHg que chez ceux qui ne présentaient pas de modification de PVC. De manière globale, les performances du test sont excellentes, comme l'atteste une méta-analyse de Cavallaro et al [24].…”

“…De manière globale, les performances du test sont excellentes, comme l'atteste une méta-analyse de Cavallaro et al [24]. Notons cependant que celle-ci incluait 178 patients et n'a pas pris en compte les études moins favorables de Mahjoub et al [25] (41 patients) et de Lakhal et al [23] (102 patients). Cette méta-analyse devrait donc être actualisée.…”

Combined analysis of cardiac output and CVP changes remains the best way to titrate fluid administration in shocked patients

“…But the performance of its surrogate PLR-PP was clinically inconsistent as already suggested [2,8]. Therefore, generalised use of PLR-PP as a marker of SV change induced by PLR cannot be supported [10]. Although only half of the included patients increased C2 mmHg in CVP during PLR, the PLR-PP test performed better among these patients than in the overall population [AUC: 0.91 (0.79-0.97)].…”

“…In the present issue, Lakhal et al [10] present the results of a multicenter study testing the predictive value of PLR for fluid responsiveness. They used thermodilution techniques to assess cardiac output (CO) changes during PLR (PLR-CO) and arterial pulse pressure (PP) changes during PLR (PLR-PP) as a surrogate for stroke volume (SV) [1,2].…”