Echocardiography Evaluation of the Effects of Midazolam on Passive Leg Raising Test in Critically ill Patients in the Intensive Care Unit, diagnosed with Sepsis, determined to be hypovolemic and responding to fluid treatment

Abstract

Background This study used echocardiography parameters to investigate the effects of midazolam sedation on intravascular volume in intubated patients who are diagnosed with sepsis and treated with invasive mechanical ventilation in continuous positive airway pressure mode. Methods This study included 152 intensive care unit patients aged 30–50 years with spontaneous breathing; all were intubated, had their lungs ventilated with a positive end-expiratory pressure of 5 cmH2O in continuous positive airway pressure mode via invasive mechanical ventilation, had a Ramsey sedation scale score of 5–6 at 5 min after midazolam administration, and exhibited a fluid deficit (i.e., inferior vena cava collapsibility index > 42% and > 12% systolic arterial pressure increase in the passive leg raising test). Cardiac index, cardiac output, and velocity time integral measurements were taken after the passive leg raising test, before and after midazolam sedation, in patients with hypovolaemia who responded to fluid treatment. Changes in passive leg raising test results were compared before and after administration of midazolam. Results Cardiac output > 15%, cardiac index > 10%, and > 15% increase in velocity time integral during the passive leg raising test before midazolam administration indicated that patients exhibited hypovolaemia and responded to fluid therapy. Cardiac output < 15%, cardiac index < 10%, and < 15% increase in velocity time integral during the passive leg raising test after midazolam administration indicated that patients did not exhibit hypovolaemia. Conclusions We recommend that the passive leg raising test, which is used to determine intravascular volume status of critically ill intensive care unit patients who exhibit hypovolaemia and respond to fluid therapy, should be performed before midazolam sedation.