Precision and consistency of the passive leg raising maneuver for determining fluid responsiveness with bioreactance non-invasive cardiac output monitoring in critically ill patients and healthy volunteers

Abstract

ObjectiveThe passive leg raising (PLR) maneuver has become standard practice in fluid resuscitation. We aim to investigate the precision and consistency of the PLR for determining fluid responsiveness in critically ill patients and healthy volunteers using bioreactance non-invasive cardiac output monitoring (NiCOM™, Cheetah Medical, Inc., Newton Center, Massachusetts, USA).MethodsThis study is prospective, single-center, observational cohort with repeated measures in critically ill patients admitted to the medical intensive care unit and healthy volunteers at a tertiary academic medical center. Three cycles of PLR were performed, each at 20–30 minutes apart. Fluid responsiveness was defined as a change in stroke volume index (ΔSVI) > 10% with each PLR as determined by NiCOM™. Precision was the variability in ΔSVI after the 3 PLR’s, and determined by range, average deviation and standard deviation. Consistency was the same fluid responsiveness determination of “Yes” (ΔSVI > 10%) or “No” (ΔSVI ≤ 10%) for all 3 PLR’s.ResultsSeventy-five patients and 25 volunteers were enrolled. In patients, the precision was range of 17.2±13.3%, average deviation 6.5±4.0% and standard deviation 9.0±5.2%; and for volunteers, 17.4±10.3%, 6.6±3.8% and 9.0±6.7%, respectively. There was no statistical difference in the precision measurements between patients and volunteers. Forty-nine (65.3%) patients vs. twenty-four (96.0%) volunteers had consistent results, p < 0.01. Among those with consistent results, twenty-four (49.0%) patients and 24 (100%) volunteers were fluid responsive.ConclusionsThe precision and consistency of determining ΔSVI with NiCOM™ after PLR may have clinical implication if ΔSVI > 10% is the absolute cutoff to determine fluid responsiveness.

Change in Carotid Blood Flow and Carotid Corrected Flow Time Assessed by Novice Sonologists Fails to Determine Fluid Responsiveness in Spontaneously Breathing Intensive Care Unit Patients

“…(Vistisen et al 2017) In addition, a 2018 study demonstrated that PLR tests repeated within the same critically ill patients lack precision; over 35% of patients demonstrated results that were not reproducible. (Chopra et al 2019) Our use of a fluid bolus differs from work by Barjaktarevic, et al, and could in part explain the discordant results. ( 2018)…”

Inferring the Frank–Starling Curve From Simultaneous Venous and Arterial Doppler: Measurements From a Wireless, Wearable Ultrasound Patch

“…Accordingly, if the Frank–Starling mechanism is analogized to a “dose–response” curve, then the venous Doppler velocity morphology tells the clinician that different PLR maneuvers have “dosed” the heart equitably. In this manner, determining that the PLR truly modifies cardiac preload may partly explain conflicting data on the reproducibility of the PLR maneuver ( 36 ).…”

Bioreactance-Based Noninvasive Fluid Responsiveness and Cardiac Output Monitoring: A Pilot Study in Patients with Aneurysmal Subarachnoid Hemorrhage and Literature Review

“…Waldron et al found that the agreement between monitors was 60% and 66% at 5 and 15 minutes, respectively, using a 10% increase in SV after fluid challenge, with no systematic disagreement at any point, while Pascale et al demonstrated a higher accuracy for predicting fluid responsiveness of about 80% (sensitivity 80%; specificity 82.6%) with NICOM relative to EDM. Chopra et al showed that the percent change in SV index measured by NICOM after a PLR has a precision of ±9% (standard deviation) in both critically ill patients and healthy volunteers [ 54 ]. Stroke volume variability from NICOM has been demonstrated to successfully predict fluid responsiveness in patients requiring a prone positioning [ 55 ].…”