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Can passive leg raise predict the response to fluid resuscitation in ED?

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journal contribution
posted on 2023-01-20, 16:29 authored by MH Elwan, A Roshdy, EM Elsharkawy, SM Eltahan, TJ Coats

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.

Funding

ME is funded by Newton-Mosharafa PhD Fund. ME and TC secured further project funding through the RCEM grant award scheme (no. G/2017/1)

History

Citation

Elwan MH, Roshdy A, Elsharkawy EM, Eltahan SM, Coats TJ. Can passive leg raise predict the response to fluid resuscitation in ED? BMC Emerg Med. 2022 Oct 26;22(1):172. doi: 10.1186/s12873-022-00721-6. PMID: 36289475; PMCID: PMC9608892.

Author affiliation

Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

BMC EMERGENCY MEDICINE

Volume

22

Issue

1

Pagination

172

Publisher

BMC

issn

1471-227X

eissn

1471-227X

Acceptance date

2022-09-20

Copyright date

2022

Available date

2023-01-20

Spatial coverage

England

Language

English