Can passive leg raise predict the response to fluid resuscitation in ED?
Abstract 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 depart...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-10-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-022-00721-6 |
| _version_ | 1797989845358870528 |
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| author | MH Elwan A Roshdy EM Elsharkawy SM Eltahan TJ Coats |
| author_facet | MH Elwan A Roshdy EM Elsharkawy SM Eltahan TJ Coats |
| author_sort | MH Elwan |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-11T08:26:59Z |
| format | Article |
| id | doaj.art-9d9e3f1398ea4a6d983fd522f39096dc |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-04-11T08:26:59Z |
| publishDate | 2022-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-9d9e3f1398ea4a6d983fd522f39096dc2022-12-22T04:34:43ZengBMCBMC Emergency Medicine1471-227X2022-10-0122111010.1186/s12873-022-00721-6Can passive leg raise predict the response to fluid resuscitation in ED?MH Elwan0A Roshdy1EM Elsharkawy2SM Eltahan3TJ Coats4Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of LeicesterDepartment of Critical Care Medicine, Alexandria UniversityDepartment of Cardiology, Alexandria UniversityDepartment of Cardiology, Alexandria UniversityEmergency Medicine Academic Group, Department of Cardiovascular Sciences, University of LeicesterAbstract 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.https://doi.org/10.1186/s12873-022-00721-6Preload responsivenessFluid therapyHaemodynamicsEmergencyNon-invasive monitoringBioimpedance |
| spellingShingle | MH Elwan A Roshdy EM Elsharkawy SM Eltahan TJ Coats Can passive leg raise predict the response to fluid resuscitation in ED? BMC Emergency Medicine Preload responsiveness Fluid therapy Haemodynamics Emergency Non-invasive monitoring Bioimpedance |
| 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 | Preload responsiveness Fluid therapy Haemodynamics Emergency Non-invasive monitoring Bioimpedance |
| url | https://doi.org/10.1186/s12873-022-00721-6 |
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