Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis*

Preau, Sébastien; Saulnier, F.; Dewavrin, Florent; Durocher, A.; Chagnon, Jean-Luc

doi:10.1097/ccm.0b013e3181c8fe7a

Cited by 204 publications

(149 citation statements)

References 30 publications

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“…Dynamic indices had better AUROC and correlation than static measures across studies. Furthermore, in addition to [12] Prospective observational study 2b 13 Feissel et al 2005 [13] Prospective observational study 2b 15 Natalini st al 2006 [14] Prospective observational study 2b 16 Solus-Biguenet et al 2006 [15] Prospective observational study 2b 15 Cannesson et al 2006 [16] Prospective observational study 2b 15 Lamia et al 2007 [17] Prospective observational study 2b 14 Soubrier et al 2007 [18] Prospective observational study 2b 15 Belloni et al 2008 [19] Prospective observational study 2b 16 Cannesson et al 2008 [20] Prospective observational study 2b 15 Auler et al 2008 [21] Prospective observational study 2b 14 Huang et al 2008 [22] Prospective observational study 2b 13 Biais et al 2008 [23] Prospective observational study 2b 13 Keller et al 2008 [24] Prospective observational study 2b 12 Mutoh et al 2009 [25] Randomised non-blinded study 2b 13 Ranucci et al 2009 [26] Prospective observational study 2b 15 Gouvea et al 2009 [27] Prospective observational study 2b 15 Cannesson et al 2009 [28] Prospective observational study 2b 15 Biais et al 2009 [29] Prospective observational study 2b 15 Skulec et al 2009 [30] Randomised blinded study 2b 16 Preau et al 2010 [31] Prospective observational study 2b 15 Delerme et al 2010 [32] Prospective observational study 2b 15 Desgranges et al 2011 [33] Prospective observational study 2b 14 Guinot et al 2011 [34] Prospective observational study 2b 15 Muller et al 2011 [35] Prospective observational study 2b 14 Muller et al 2012 [36] Prospective observational study 2b 15 de Oliveira-Costa et al 2012 [37] Cross-sectional observational study 2b 14 Feissel et al 2013 [38] Prospective observational study 2b 14 Brun et al 2013 [39] Prospective observational study 2b 15 Chin et al 2013 [40] Prospective observational study 2b 15 Wu et al 2014 …”

Section: Discussionmentioning

confidence: 99%

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

et al. 2015

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SummaryAccurate assessment of intravascular fluid status and measurement of fluid responsiveness have become increasingly important in peri-operative medicine and critical care. The objectives of this systematic review and narrative synthesis were to discuss current controversies surrounding fluid responsiveness and describe the merits and limitations of the major cardiac output monitors in clinical use today in terms of usefulness in measuring fluid responsiveness. We searched the MEDLINE and EMBASE databases (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015); inclusion criteria included comparison with an established reference standard such as pulmonary artery catheter, transthoracic echocardiography and transoesophageal echocardiography. Examples of clinical measures include static (such as central venous pressure) and dynamic (such as stroke volume variation and pulse pressure variation) parameters. The static parameters measured were described as having little value; however, the dynamic parameters were shown to be good physiological determinants of fluid responsiveness. Due to heterogeneity of the methods and patient characteristics, we did not perform a meta-analysis. In most studies, precision and limits of agreement (bias AE1.96SD) between determinants of fluid responsiveness measured by different devices were not evaluated, and the definition of fluid responsiveness varied across studies. Future research should focus on the physiological principles that underlie the measurement of fluid responsiveness and the effect of different volume expansion strategies on outcomes.

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Section: Discussionmentioning

confidence: 99%

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

et al. 2015

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“…The positive response to PLR was defined by an increase in CO TTE C 10%. 13 The highest value of CO TTE was observed within the first 90 sec following the PLR maneuver. 14 The highest value of CO esCCO was recorded during the period ranging from the beginning of the PLR to two minutes after the highest value of CO TTE , in accordance with the fact that PWTT was calculated by averaging 64 consecutive heart beats.…”

Section: Study Protocolmentioning

confidence: 88%

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

Fischer

Balaire

Kergal

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Estimated continuous cardiac output (esCCO) is a new and noninvasive cardiac output (CO) monitoring device using pulse wave transit time. The aim of this study was to assess rapid changes in CO using esCCO (DCO esCCO ) without invasive calibration and to compare the results with those using transthoracic Doppler echocardiography (DCO TTE ). Methods Fifty-four consecutive patients were enrolled in this study following elective cardiac surgery. The CO esCCO and CO TTE were collected during four consecutive steps: 1) at baseline, 2) during passive leg raising (PLR), 3) at return to baseline, and 4) after a fluid challenge. The relationship between DCO esCCO and DCO TTE induced by PLR and a fluid challenge was assessed and a polar plot analysis was performed. Relationship, Bland-Altman analysis, and percentage error for absolute values of CO esCCO and CO TTE were also performed. Results Twenty-four patients were excluded from the analysis. No correlation was found between DCO esCCO and DCO TTE during PLR (r = 0.07; P = 0.732; n = 30) and after a fluid challenge (r = 0.24; P = 0.394; n = 14). The polar plot analysis showed that 21 data points (87%) of significant changes in CO were above the 30°radial sector lines and confirmed that esCCO was unable to track changes in CO. A weak positive relationship was found between absolute values of CO esCCO and CO TTE (r = 0.28; P = 0.004). Bias, precision, and limits of agreement were 0.25 LÁmin -1 , 2.4 LÁmin -1 , and -4.4 to 4.9 LÁmin -1 , respectively. The percentage error was 80%. Conclusions Estimated continuous cardiac output without external calibration seems unable to assess rapid changes in CO following cardiac surgery and was not interchangeable with transthoracic Doppler echocardiography.

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“…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)…”

Section: Discussionmentioning

confidence: 99%

“…Pooled (13) 1.00 (0.72 -1.00) Maizel (14) 0.82 (0.57 -0.96) Thiel (15) 0.93 (0.82 -0.98) Biais (17) 0.90 (0.55 -1.00) Préau (18) 0.90 (0.68 -0.99) Guinot (19) 0.90 (0.68 -0.99) Wang (21) 0.83 (0.52 -0.98) Monnet (22) 0.91 (0.71 -0.99) García (23) 0.94 (0.70 -1.00)…”

Section: Sensitivity (95% Ci)mentioning

confidence: 99%

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

Xiang¹,

Cao²,

Wu³

et al. 2016

IJCM

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Objective: To analyze the accuracy and specificity of recent studies to compare the ability of predicting fluid responsiveness with Passive Leg Raising (PLR) by using invasive or non-invasive techniques during passive leg raising. Data Sources: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were systematically searched. Study Selection: Clinical trials that reported the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) between the responder and non-responder induced by passive leg raising and Volume Expansion (VE) in critical ill patients were selected. 246 studies were screened, 14 studies were included for data extraction, which met our inclusion criteria. Data Extraction: Data were abstracted on study characteristics, patient population, type and amount of VE, time of VE, definition of responders, position, techniques used for measuring hemodynamic change, number and percentage of responders, the correlation coefficient, sensitivity, specificity, best threshold and area under the ROC curve (AUC). Meta-analytic techniques were used to summarize the data. Data Synthesis: A total of 524 critical ill patients from 14 studies were analyzed. Data are reported as point estimate (95% confidence intervals). The pooled sensitivity and specificity of invasive techniques were 80% (73% -85%) and 89% (84% -93%) respectively with the area under the sROC of 0.94. While, the pooled sensitivity and specificity of non-invasive techniques were 88% (84% -92%) and 91% (86% -94%) respectively with the area under the sROC of 0.95. The pooled DOR of invasive techniques was 32.2 (13.6 -76.8), which was much lower than that of non-invasive techniques with the value of 64.3 (33.9 -121.7). Conclusions: The hemodynamic indexes changes induced by PLR could reliably predict fluid responsiveness. Non-invasive hemodynamic techniques with their accuracy and safety can benefit the daily work in ICUs. Because the numHow to cite this paper:

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Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis*

Abstract: Changes in stroke volume, radial pulse pressure, and peak velocity of femoral artery flow induced by passive leg raising are accurate and interchangeable indices for predicting fluid responsiveness in nonintubated patients with severe sepsis or acute pancreatitis.

Cited by 204 publications

References 30 publications

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review

The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography

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

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