Echocardiography and passive leg raising in the postoperative period

Hadouti, Yasser El; Valencia, Lucía; Becerra, Ángel Ignacio Lledó; Rodríguez‐Pérez, Aurelio; Vincent, Jean‐Louis

doi:10.1097/eja.0000000000000679

Cited by 16 publications

(17 citation statements)

References 20 publications

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“…In recent years, bedside ultrasonography has been considered as a noninvasive, real-time, convenient, low-cost, and repeatable tool for monitoring hemodynamics [10,11,[19][20][21]. Previous studies have con rmed that echocardiography was highly correlated with PICCO in CO and SV, and PLR combined with non-invasive ultrasound has signi cant advantages in evaluating FR, which can be determined by monitoring SV and aortic blood ow [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Passive leg raising (PLR) is a simple repeatable self-replenishing uid method done to shift venous blood from the lower limbs toward the intrathoracic compartment [8,9]. Transthoracic Doppler echocardiography (TTE ) is a non-invasive method that allows for real-time monitoring of the descending aortic blood ow, and the estimation of SV [10,11].…”

Section: Introductionmentioning

confidence: 99%

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The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

Luo

Dai

Lei

et al. 2020

Preprint

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Background: There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor of FR in children with mechanical ventilation after congenital cardiac surgery. Methods: A total of 40 children with mechanical ventilation following congenital cardiac surgery, who required volume expansion (VE) were included in this study. Hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP), SV, and central venous pressure (CVP) were monitored before and after PLR and VE. Besides, we assessed changes in SV and CO by bedside ultrasound. Patients showing >10% increase in SV in response to VE were considered to be responders (26 patients), while the rest (14 patients) were defined as non-responders. Results: Our data demonstrated that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, p <0.001 and r = 0.374, p = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95% CI [0.745 1.000], p < 0.001). The best cut-off value for ΔSV-PLR in predicting FR was 13%, with its sensitivity and specificity were 81.8% and 86.3%, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictors of FR in the children. Conclusion: Our study demonstrated that SV changes, as evaluated by noninvasive ultrasound combined with PLR, could effectively evaluate FR in children under mechanical ventilation following congenital cardiac surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

Luo

Dai

Lei

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…In recent years, bedside ultrasonography has been considered as a noninvasive, real-time, convenient, low-cost, and repeatable means of hemodynamic monitoring [10,11,[19][20][21]. Previous studies have confirmed that echocardiography was highly correlated with PICCO in CO and SV, and PLR combined with non-invasive ultrasound has significant advantages in evaluating FR, which can be determined by monitoring SV and aortic blood flow [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…Passive leg raising (PLR) is a repeatable self-replenishing fluid method by shifting venous blood from the lower limbs toward the intrathoracic compartment [8,9].Transthoracic Doppler echocardiography ( TTE ) is a non-invasive method that allows for real-time monitoring of the descending aortic blood flow, and the estimation of SV [10,11]. Therefore, using the bedside ultrasound to measure the variation of SV induced by PLR may be used to evaluate FR in these children patients.…”

Section: Introductionmentioning

confidence: 99%

The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

Luo

Dai

Lei

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: There are few non-invasive monitoring methods that can reliably predict FR in children, this article aims to investigate the value of the doppler ultrasound evaluation of passive leg raising (PLR) induced changes in stroke volume (SV) and cardiac output(CO) in predicting the fluid responsiveness (FR) in children with mechanical ventilation after congenital cardiac surgery. Methods: A total of 40 children with mechanical ventilation after congenital cardiac surgery who requiring volume expansion (VE) were eventually included in this observational study. Hemodynamic parameters such as heart rate (HR), blood pressure, SV, and central venous pressure (CVP) were monitored before and after PLR and VE respectively, and changes of SV and CO were assessed by bedside ultrasound as well. The patients showing an increase in SV >10% in response to VE were considered responders (26 patients), and the rest were defined as nonresponders (14 patients). Results: The results showed that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, P<0.001 and r= 0.374, P = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95% CI [0.745 1.000], P < 0.001). The best cut-off value of ΔSV-PLR for predicting FR was 13%, with its sensitivity and specificity was 81.8% and 86.3%, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictive FR in children patients. Conclusion: Our study demonstrated that SV changes assessed by noninvasive ultrasound combined with PLR could be a feasible method for evaluating fluid responsiveness in children with congenital cardiac surgery and mechanical ventilation. Keywords: congenital heart surgery; fluid responsiveness; passive leg raising; ultrasound.

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“…Dynamic echocardiographic parameters, especially CO variation due to volume infusion or volume shift after PLR, are excellent predictors of volume responsiveness. 14,16–19 CO is the amount of blood pumped by the heart per minute and is dependent on the heart rate, myocardial contractility, preload, and afterload. In healthy individuals, the right and left ventricles pump the same volume of blood, therefore, measurements of left and right ventricular CO are equal.…”

Section: Discussionmentioning

confidence: 99%

A novel prediction of simulated fluid responsiveness by echocardiography assessment of tricuspid annulus tissue velocity with passive leg raising

Ünlüer

Karagöz

Bayata

et al. 2019

Hong Kong Journal of Emergency Medicine

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Background: Fluid responsiveness can be predicted by the effect of passive leg raising on cardiac output. Objectives: This research aimed to compare the changes in cardiac output and the peak systolic velocity values of Tricuspid annulus velocity at the free wall (S’) before and after passive leg raising in healthy volunteers. Methods: The study was approved by ethical commission. The desired sample size was 28, and 57 volunteers were included after they signed informed consent. The first measurements, including vital signs, S’, and cardiac output, were taken with the participants lying supine and were performed in the morning after 12 h fast. The participants were then asked to lie in a semirecumbent position for 3 min. After 3 min, the head of the bed was lowered to the supine position and the participants’ legs were elevated at 45°. Secondary measurements were repeated in this position. The differences between vital signs, cardiac output, and S’ measurements before and after passive leg raising were statistically compared. The level of significance was set as p < 0.05. Results: The mean values of cardiac output and S’ before passive leg raising was 9.59 L/min and 11.57 cm/s, respectively; however, those increased to 11.44 L/min and 13.72 cm/s after passive leg raising. The average increases were 16.17% for cardiac output and 15.67% for S’. The changes of cardiac output and S’ were statistically significant. The changes of vital signs before and after passive leg raising were statistically insignificant. Conclusion: This study has demonstrated the concordance of rise in cardiac output with S’ change by passive leg raising in healthy subjects. Further studies are needed to validate the use of S’ values in critically ill subjects.

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Echocardiography and passive leg raising in the postoperative period

Abstract: This is the first study showing that measurement of CO after PLR can predict volume response in spontaneously breathing postoperative patients.

Cited by 16 publications

References 20 publications

The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery

A novel prediction of simulated fluid responsiveness by echocardiography assessment of tricuspid annulus tissue velocity with passive leg raising

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