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Clinical study of passive leg raising as an indicator of fluid responsiveness in severe septic patients

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Author:
No author available
Journal Title:
Chinese Journal of Emergency Medicine
Issue:
4
DOI:
10.3760/cma.j.issn.1671-0282.2012.04.007
Key Word:
被动直腿抬高试验;液体复苏;血流动力学监测;每搏量指数;中心静脉压;严重脓毒症;液体反应;ROC曲线;Passive leg raising;Fluid resuscitation;Hemodynamic monitoring;Stroke volumeindex;Central venous pressure;Severe sepsis;Fluid responsiveness;ROC curve

Abstract: Objective To assess the value of legs passively lifted as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis.Methods Twenty-eight mechanically ventilated patients with severe sepsis admitted from May 2010 to May 2011 for volume resuscitation were collected.Patients with non-sinus rhythm or arrhythmia and parturients were excluded. Variation of hemodynamics of the patients in a semi-recumbent position,after passive leg raising (PLR) and after volume expansion (500 ml 6% hydroxyethyl starch infusion within 30 mins) was studied by using the technique of pulse indicator continuous cardiac output (PiCCO) system.The volume resuscitation were resulted into two groups,responder and non-responder,as per △SVI (stroke volume index) over 15%.HR,arterial systoicblood pressure (ABPs),arterial diastolic blood pressure (ABPd),mean arterial blood pressure (ABPm),mean central venous pressure (CVPm) and cardiac index (CI) were compared between two groups.The changes of ABPs,ABPm,CVPm and SVI after PLR and after fluid resuscitation werc compared with those before PLR and fluid resuscitation.The ROC curve was drawn to evaluate the value of △SVI and △CVPm in predicting volume responsiveness. SPSS 17.0 software was used for statistic analysis. Results Of 28 patients,8 were responders and 10 were non-responders.In responders after PLR,some hemodynamic variables including ABPs,ABPm and CVPm were significantly increased [(100.1 ± 18.1) vs.(115.9 ±13.1),P=0.005; (68.1±12.4) vs.(77.8±13.0),P=0.03and(7.2±3.4) vs.(10.1±4.1),P=0.03,respectively ].After PLR,the area under curve (AUC) of the ROC curve of △SVI and △CVPm to predict the responsiveness after fluid resuscitation were 0.897 ± 0.059 (95 % CI 0.762-1.000) and 0.819±0.081 (95%CI 0.661-0.977),respectively.When the cut-off levels of △SVI and △CVPm were 10.5% and 12.7%,the sensitivities were 72.2% and 72.2%,the specificities were 90% and 80%.Conclusions Changes in △SVI and △CVPm induced by passive leg raising are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.

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