The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

Duus, Nicolaj; Shogilev, Daniel J.; Skibsted, Simon; Zijlstra, H.; Fish, Emily; Oren-Grinberg, Achikam; Lior, Yotam; Novack, Victor; Talmor, Daniel; Kirkegaard, Hans; Shapiro, Nathan I.

doi:10.1016/j.jcrc.2014.07.031

Cited by 33 publications

(38 citation statements)

References 17 publications

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“…A sample size of 40 was estimated based on detecting a 10% difference in hemodynamic change compared to no change, with 90% power and an alpha of 0.05. Twenty‐second averaging was used to track peak change in hemodynamic measurements for the fluid bolus and PLR maneuver, as has been previously described . The study was originally designed to use 60‐second averaging, but this technique was changed to be consistent with the existing literature using the device.…”

Section: Methodsmentioning

confidence: 99%

Assessing Fluid Responsiveness in Spontaneously Breathing Patients

Miller

Tang

et al. 2016

Academic Emergency Medicine

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Objectives: The primary objective of this study was to test if fasting volunteers exhibit fluid responsiveness using noninvasive hemodynamic measurements. The secondary objective was to test a passive leg raise (PLR) maneuver as a diagnostic predictor of fluid responsiveness.Methods: This was a quasi-experimental design involving healthy volunteers. Subjects were excluded for pregnancy and congestive heart failure. Following a 12-hour fast, subjects had baseline hemodynamic monitoring recorded using noninvasive, continuous pulse contour analysis. Subjects then had a PLR maneuver performed, followed by an intravenous bolus of crystalloid. A rise in stroke volume ≥ 10% from baseline with the bolus was considered consistent with fluid responsiveness, and the same rise with a PLR was consistent with a positive PLR maneuver. The primary outcome was the change in stroke volume with a fluid bolus. Univariate analysis assessed changes in hemodynamic parameters. Logistic regression analysis determined the test characteristics of the PLR in predicting subjects who were ultimately fluid responsive.Results: Forty subjects completed the study. The mean change in stroke volume with a crystalloid bolus was 19% (95% confidence interval [CI] = 16% to 21%). Thirty-six (90%) subjects were fluid responsive. The mean PLR response for the overall cohort was 16% (95% CI = 12% to 19%), and 26 (65%) subjects had a positive PLR maneuver. The PLR was 72% sensitive (95% CI = 55% to 85%) and 100% specific (95% CI = 40% to 100%) for predicting the presence of fluid responsiveness.Conclusions: Noninvasive assessment of fluid responsiveness in healthy volunteers and prediction of this response with a PLR maneuver is achievable. Further work is indicated to test these methods in acutely ill patients.ACADEMIC EMERGENCY MEDICINE 2016;23:186-190

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Section: Methodsmentioning

confidence: 99%

Assessing Fluid Responsiveness in Spontaneously Breathing Patients

Miller

Tang

et al. 2016

Academic Emergency Medicine

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“…Previous studies have shown that only about 50% of hemodynamically unstable patients will respond to a fluid bolus . One tool used to determine who will respond to a volume challenge is the passive leg raising (PLR) test . Raising the legs 45° from the horizontal position of a supine patient delivers approximately a 300‐cc bolus of blood from the lower extremities into the thoracic cavity .…”

Section: Recognition and Treatment Of Volume Overloadmentioning

confidence: 99%

“…3,4 One tool used to determine who will respond to a volume challenge is the passive leg raising (PLR) test. [30][31][32] Raising the legs 45°f rom the horizontal position of a supine patient delivers approximately a 300-cc bolus of blood from the lower extremities into the thoracic cavity. 4,30 An increase in cardiac output, carotid blood flow, or aortic blood flow after PLR 31,33,34 (all of which can be measured noninvasively) suggests patients will respond to additional fluids; the correlate is that unnecessary fluids can be avoided in those patients who do not respond.…”

Section: In the Australian And New Zealandmentioning

confidence: 99%

Euvolemia—A critical target in the management of acute kidney injury

Colbert

Szerlip

2018

Seminars in Dialysis

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It has been clearly established that critically ill patients with sepsis require prompt fluid resuscitation. The optimal amount of fluid and when to taper this resuscitation is less clear. There is a growing evidence that fluid overload leads to acute kidney injury, and increased morbidity and mortality. A clinician's best intentions in resuscitating a patient can lead to too much of a good thing. Currently, there are several bedside tools to aid in determining a patient's response to a fluid challenge as well as in the assessment of the current volume status. Guidelines are not available on the exact rate of fluid overload removal and what medicinal or mechanical modality is most favorable. We discuss our experience and an examination of the literature on the problems with fluid overload, and how a patient may benefit from forced fluid removal.

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“…Using the NICOM (NonInvasive Cardiac Output Monitor; Cheetah Medical, Tel Aviv, Israel), recent studies found PLR to be a promising tool for the evaluation of fluid responsiveness [42,43]. Echocardiographic assessment of changes in stroke volume due to PLR have also been demonstrated to be useful predictors for fluid responsiveness [44].…”

Section: Left Ventricular Outflow Tract (Lvot) Velocity Time Integralmentioning

confidence: 99%

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

Vermeiren¹,

Malbrain

Walpot³

2015

Anaesthesiol Intensive Ther

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Cardiac ultrasonography has become an indispensible tool in the management of hemodynamically unstable critically ill patients. Some consider it as the modern stethoscope. Echocardiography is non-invasive and safe while the modern portable devices allow to be used at the bedside in order to provide fast, specific and vital information regarding the hemodynamic status, as well as the function, structure and anatomy of the heart. In this review, we will give an overview of cardiac function in general followed by an assessment of left ventricular function using echocardiography with calculation of cardiac output, left ventricular ejection fraction (EF), fractional shortening, fractional area contraction, M mode EF, 2D planimetry and 3D volumetry. We will briefly discuss mitral annulus post systolic excursion (MAPSE), calculation of dP/dt, speckle tracking or eyeballing to estimate EF for the experienced user. In a following section, we will discuss how to assess cardiac preload and diastolic function in 4 simple steps. The first step is the assessment of systolic function. The next step assesses the left atrium. The third step evaluates the diastolic flow patterns and E/e' ratio. The final step integrates the information of the previous steps. Echocardiography is also the perfect tool to evaluate right ventricular function with tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging, together with inferior vena cava dimensions and systolic pulmonary artery pressure and right ventricular systolic pressure measurement. Finally, methods to assess fluid responsiveness with echocardiography are discussed with the inferior vena cava collapsibility index and the variation on left ventricle outflow tract peak velocity and velocity time integral. Cardiac ultrasonography is an indispensible tool for the critical care physician to assess cardiac preload, afterload and contractile function in hemodynamically unstable patients in order to fine-tune treatment with fluids, inotropes and/or vasopressors.

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The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

Cited by 33 publications

References 17 publications

Assessing Fluid Responsiveness in Spontaneously Breathing Patients

Assessing Fluid Responsiveness in Spontaneously Breathing Patients

Euvolemia—A critical target in the management of acute kidney injury

Cardiac Ultrasonography in the critical care setting: a practical approach to asses cardiac function and preload for the “non-cardiologist”

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