Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and Vigileo™/FloTrac™ device

Abstract

IntroductionPassive leg raising (PLR) is a simple reversible maneuver that mimics rapid fluid loading and increases cardiac preload. The effects of this endogenous volume expansion on stroke volume enable the testing of fluid responsiveness with accuracy in spontaneously breathing patients. However, this maneuver requires the determination of stroke volume with a fast-response device, because the hemodynamic changes may be transient. The Vigileo™ monitor (Vigileo™; Flotrac™; Edwards Lifesciences, Irvine, CA, USA) analyzes systemic arterial pressure wave and allows continuous stroke volume monitoring. The aims of this study were (i) to compare changes in stroke volume induced by passive leg raising measured with the Vigileo™ device and with transthoracic echocardiography and (ii) to compare their ability to predict fluid responsiveness.MethodsThirty-four patients with spontaneous breathing activity and considered for volume expansion were included. Measurements of stroke volume were obtained with transthoracic echocardiography (SV-TTE) and with the Vigileo™ (SV-Flotrac) in a semi-recumbent position, during PLR and after volume expansion (500 ml saline). Patients were responders to volume expansion if SV-TTE increased ≥ 15%.ResultsFour patients were excluded. No patients received vasoactive drugs. Seven patients presented septic hypovolemia. PLR-induced changes in SV-TTE and in SV-Flotrac were correlated (r2 = 0.56, P < 0.0001). An increase in SV-TTE ≥ 13% during PLR was predictive of response to volume expansion with a sensitivity of 100% and a specificity of 80%. An increase in SV-Flotrac ≥16% during PLR was predictive of response to volume expansion with a sensitivity of 85% and a specificity of 90%. There was no difference between the area under the ROC curve for PLR-induced changes in SV-TTE (AUC = 0.96 ± 0.03) or SV-Flotrac (AUC = 0.92 ± 0.05). Volume expansion-induced changes in SV-TTE correlated with volume expansion-induced changes in SV-Flotrac (r2 = 0.77, P < 0.0001). In all patients, the highest plateau value of SV-TTE recorded during PLR was obtained within the first 90 s following leg elevation, whereas it was 120 s for SV-Flotrac.ConclusionsPLR-induced changes in SV-Flotrac are able to predict the response to volume expansion in spontaneously breathing patients without vasoactive support.

Does pneumoperitoneum affect perfusion index and pleth variability index in patients receiving combined epidural and general anesthesia?

“…The position of the patient during measurements was kept horizontal. CO, SVV, SVI, and SVR were recorded 20 sec after SAP, DAP, HR, and P ET CO 2 were recorded because the Vigileo™ samples the pressure waveform at 100 Hz over 20 sec to capture 2,000 data points for analysis, and parameter calculations are provided at the end of every 20-sec timeframe (20,21).…”

Assessment of Volume Responsiveness During Mechanical Ventilation: Recent Advances

“…Th is aspect is particularly true in septic patients in whom capillary leak may account for an attenuation of the PLR eff ects after one minute, as already described [22]. Th is is why clinical studies that ha ve tested the value of PLR to predict volume responsiveness used real-time hemodynamic measurements, such as aortic blood fl ow measured by esophageal Doppler [22,41], pulse contour analysis-derived ca rdiac output [16,26,42], cardiac output measured by bio reacta nce [4 3,44] or endotracheal bioimpedance cardi ograph y [45], subaortic blood velocity measured by echocardiography [46][47][48], ascending aortic velocity measure d by s uprasternal Doppler [49] and, more recently, end-tidal carbon dioxide [50,51].…”

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

“…The main finding of our systematic review are as follows: (1) The result of pooled sensi- (12) 0.97 (0.86 -1.00) Lamia (13) 0.77 (0.46 -0.95) Maizel (14) 0.88 (0.64 -0.99) Thiel (15) 0.81 (0.67 -0.91) Biais (17) 0.85 (0.62 -0.97) Préau (18) 0.86 (0.57 -0.98) Guinot (19) 0.85 (0.55 -0.98) Wang (21) 1.00 (0.86 -1.00) Monnet (22) 0.82 (0.57 -0.96) García (23) 0.95 (0.76 -1.00)…”