Cargando…

Can passive leg raise predict the response to fluid resuscitation in ED?

OBJECTIVE: Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED...

Descripción completa

Detalles Bibliográficos
Autores principales: Elwan, MH, Roshdy, A, Elsharkawy, EM, Eltahan, SM, Coats, TJ
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608892/
https://www.ncbi.nlm.nih.gov/pubmed/36289475
http://dx.doi.org/10.1186/s12873-022-00721-6
_version_ 1784818879258689536
author Elwan, MH
Roshdy, A
Elsharkawy, EM
Eltahan, SM
Coats, TJ
author_facet Elwan, MH
Roshdy, A
Elsharkawy, EM
Eltahan, SM
Coats, TJ
author_sort Elwan, MH
collection PubMed
description OBJECTIVE: Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED). METHODS: We recruited adult patients planned to receive a resuscitation fluid bolus. Patients were monitored using a thoracic electrical bioimpedance (TEB) cardiac output monitor (Niccomo, Medis, Germany). A 3-min PLR was carried out before and after fluid infusion. Stroke volume changes (ΔSV) were calculated and a positive response was defined as ≥ 15% increase. RESULTS: We recruited 39 patients, of which 37 were included into the analysis. The median age was 63 (50–77) years and 19 patients were females. 17 patients (46%) were fluid responders compared to 11 (30%) with positive response to PLR1. ΔSV with PLR1 and fluid bolus showed moderate correlation (r = 0.47, 95% confidence interval, CI 0.17–0.69) and 62% concordance rate. For the prediction of the response to a fluid bolus the PLR test had a sensitivity of 41% (95% CI 22–64) and specificity of 80% (95% CI 58–92) with an area under the curve of 0.59 (95% CI 0.41–0.78). None of the standard parameters showed a better predictive ability compared to PLR. CONCLUSION: Using TEB, ΔSV with PLR showed a moderate correlation with fluid bolus, with a limited accuracy to predict fluid responsiveness. The PLR test was a better predictor of fluid responsiveness than the parameters commonly used in emergency care (such as heart rate and blood pressure). These data suggest the potential for a clinical trial in sepsis comparing TEB monitored, PLR directed fluid management with standard care.
format Online
Article
Text
id pubmed-9608892
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-96088922022-10-28 Can passive leg raise predict the response to fluid resuscitation in ED? Elwan, MH Roshdy, A Elsharkawy, EM Eltahan, SM Coats, TJ BMC Emerg Med Research Article OBJECTIVE: Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED). METHODS: We recruited adult patients planned to receive a resuscitation fluid bolus. Patients were monitored using a thoracic electrical bioimpedance (TEB) cardiac output monitor (Niccomo, Medis, Germany). A 3-min PLR was carried out before and after fluid infusion. Stroke volume changes (ΔSV) were calculated and a positive response was defined as ≥ 15% increase. RESULTS: We recruited 39 patients, of which 37 were included into the analysis. The median age was 63 (50–77) years and 19 patients were females. 17 patients (46%) were fluid responders compared to 11 (30%) with positive response to PLR1. ΔSV with PLR1 and fluid bolus showed moderate correlation (r = 0.47, 95% confidence interval, CI 0.17–0.69) and 62% concordance rate. For the prediction of the response to a fluid bolus the PLR test had a sensitivity of 41% (95% CI 22–64) and specificity of 80% (95% CI 58–92) with an area under the curve of 0.59 (95% CI 0.41–0.78). None of the standard parameters showed a better predictive ability compared to PLR. CONCLUSION: Using TEB, ΔSV with PLR showed a moderate correlation with fluid bolus, with a limited accuracy to predict fluid responsiveness. The PLR test was a better predictor of fluid responsiveness than the parameters commonly used in emergency care (such as heart rate and blood pressure). These data suggest the potential for a clinical trial in sepsis comparing TEB monitored, PLR directed fluid management with standard care. BioMed Central 2022-10-26 /pmc/articles/PMC9608892/ /pubmed/36289475 http://dx.doi.org/10.1186/s12873-022-00721-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Elwan, MH
Roshdy, A
Elsharkawy, EM
Eltahan, SM
Coats, TJ
Can passive leg raise predict the response to fluid resuscitation in ED?
title Can passive leg raise predict the response to fluid resuscitation in ED?
title_full Can passive leg raise predict the response to fluid resuscitation in ED?
title_fullStr Can passive leg raise predict the response to fluid resuscitation in ED?
title_full_unstemmed Can passive leg raise predict the response to fluid resuscitation in ED?
title_short Can passive leg raise predict the response to fluid resuscitation in ED?
title_sort can passive leg raise predict the response to fluid resuscitation in ed?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9608892/
https://www.ncbi.nlm.nih.gov/pubmed/36289475
http://dx.doi.org/10.1186/s12873-022-00721-6
work_keys_str_mv AT elwanmh canpassivelegraisepredicttheresponsetofluidresuscitationined
AT roshdya canpassivelegraisepredicttheresponsetofluidresuscitationined
AT elsharkawyem canpassivelegraisepredicttheresponsetofluidresuscitationined
AT eltahansm canpassivelegraisepredicttheresponsetofluidresuscitationined
AT coatstj canpassivelegraisepredicttheresponsetofluidresuscitationined