Chest
Clinical Investigations in Critical CareChanges in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients
Section snippets
Materials and Methods
We first studied 15 consecutive patients who were admitted to the ICU for acute circulatory failure, which was defined as a systolic arterial pressure (SAP) < 90 mm Hg (or a decrease of > 50 mm Hg in previously hypertensive patients) and urine output of < 0.5 mL/kg/min for at least 2 h. All patients were receiving mechanical ventilation in a volume-controlled mode. Positive end-expiratory pressure was used in two patients and did not exceed 8 cm H2O. All patients were studied within the first 3
Results
The clinical characteristics of the patients studied are listed in Table 1.
Analysis of variance detected significant changes in BP that were induced by PLR positioning, by the return of the legs to the supine position, and by RFL, while it detected no change in BP values recorded within each phase of the procedure. Because of the stability of BP (ie, SAP, DAP, and MAP) within each phase of the PLR and RFL procedures, we expressed individual BP values as the average of the four measurements
Discussion
The main finding of our study was that changes in PPrad induced by PLR are proportional to the changes in SV that are obtained with a subsequent RFL. Therefore, simple measurements of BP during PLR could help to detect patients who will positively respond to volume expansion.
Conclusion
Our data suggest that in patients with acute circulatory failure who are receiving mechanical ventilation, the hemodynamic response to fluid loading could be predicted by simply measuring arterial pulse pressure changes during PLR. This may have two practical implications: (1) the existence of a cardiac preload dependence could be detected without the use of a Swan-Ganz catheter; and (2) a potentially harmful fluid-loading procedure could be avoided when unnecessary.
ACKNOWLEDGMENT
We thank Dr. Denis Chemla (Le Kremlin-Bicetre) for his helpful comments.
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