Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort studyReportar como inadecuado




Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 13:R111

First Online: 08 July 2009Received: 19 May 2009Accepted: 08 July 2009

Abstract

IntroductionThe assessment of volume responsiveness and the decision to administer a fluid bolus is a common dilemma facing physicians caring for critically ill patients. Static markers of cardiac preload are poor predictors of volume responsiveness, and dynamic markers are often limited by the presence of spontaneous respirations or cardiac arrhythmias. Passive leg raising PLR represents an endogenous volume challenge that can be used to predict fluid responsiveness.

MethodsMedical intensive care unit ICU patients requiring volume expansion were eligible for enrollment. Non-invasive measurements of stroke volume SV were obtained before and during PLR using a transthoracic Doppler ultrasound device prior to volume expansion. Measurements were then repeated following volume challenge to classify patients as either volume responders or non-responders based on their hemodynamic response to volume expansion. The change in SV from baseline during PLR was then compared with the change in SV with volume expansion to determine the ability of PLR in conjunction with SV measurement to predict volume responsiveness.

ResultsA total of 102 fluid challenges in 89 patients were evaluated. In 47 of the 102 fluid challenges 46.1%, SV increased by ≥15% after volume infusion responders. A SV increase induced by PLR of ≥15% predicted volume responsiveness with a sensitivity of 81%, specificity of 93%, positive predictive value of 91% and negative predictive value of 85%.

ConclusionsNon-invasive SV measurement and PLR can predict fluid responsiveness in a broad population of medical ICU patients. Less than 50% of ICU patients given fluid boluses were volume responsive.

AbbreviationsCIconfidence interval

COcardiac output

CVPcentral venous pressure

FTccorrected flow time

ICUintensive care unit

MAPmean arterial pressure

PACpulmonary artery catheter

PLRpassive leg raise

ROCreceiver operating characteristic

SVstroke volume

VEvolume expansion.

Electronic supplementary materialThe online version of this article doi:10.1186-cc7955 contains supplementary material, which is available to authorized users.

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Autor: Steven W Thiel - Marin H Kollef - Warren Isakow

Fuente: https://link.springer.com/



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