Passive leg raising test versus rapid fluid challenge in critically ill medical patients.

IF 1.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Natascha Majunke, Dan Philipp, Lorenz Weidhase, Bastian Pasieka, Kevin Kunz, Frank Seidel, Robert Scharm, Sirak Petros
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Abstract

Background: The passive leg raising (PLR) test is a simple test to detect preload responsiveness. However, variable fluid doses and infusion times were used in studies evaluating the effect of PLR. Studies showed that the effect of fluid challenge on hemodynamics dissipates in 10 min. This prospective study aimed to compare PLR and a rapid fluid challenge (RFC) with a 300-ml bolus infused within 5 min in adult patients with a hemodynamic compromise.

Materials and methods: Critically ill medical patients with signs of systemic hypoperfusion were included if volume expansion was considered. Hemodynamic status was assessed with continuous measurements of cardiac output (CO), when possible, and mean arterial pressure (MAP) at baseline, during PLR, and after RFC.

Results: A total of 124 patients with a median age of 65.0 years were included. Their acute physiology and chronic health evaluation (APACHE) II score was 19.7 ± 6.0, with a sequential organ failure assessment (SOFA) score of 9.0 ± 4.4. Sepsis was diagnosed in 73.3%, and 79.8% of the patients were already receiving a norepinephrine infusion. Invasive MAP monitoring was established in all patients, while continuous CO recording was possible in 42 patients (33.9%). Based on CO changes, compared with those with RFC, the false positive and false negative rates with PLR were 21.7 and 36.8%, respectively, with positive and negative predictive values of 70.6 and 72.0%, respectively. Based on MAP changes, compared with those with RFC, the false positive and false negative rates with PLR compared to RFC were 38.2% and 43.3%, respectively, with positive and negative predictive values of 64.4 and 54.0%, respectively.

Conclusion: This study demonstrated a moderate agreement between PLR and RFC in hemodynamically compromised medical patients, which should be considered when testing preload responsiveness.

重症内科病人的被动抬腿试验与快速输液挑战。
背景:被动抬腿(PLR)试验是检测前负荷反应性的一种简单试验。然而,在评估被动抬腿试验效果的研究中使用了不同的液体剂量和输注时间。研究表明,液体挑战对血液动力学的影响会在 10 分钟内消失。这项前瞻性研究旨在比较 PLR 和在 5 分钟内输注 300 毫升栓剂的快速液体挑战(RFC)对血液动力学受损的成年患者的影响:如果考虑扩容,则纳入有全身低灌注迹象的重症内科病人。在可能的情况下,通过连续测量基线、PLR 期间和 RFC 后的心输出量(CO)和平均动脉压(MAP)来评估血液动力学状态:共纳入 124 名患者,中位年龄为 65.0 岁。他们的急性生理学和慢性健康评估(APACHE)II 评分为(19.7 ± 6.0),序贯器官衰竭评估(SOFA)评分为(9.0 ± 4.4)。73.3%的患者确诊为败血症,79.8%的患者已在输注去甲肾上腺素。所有患者均接受了有创血压监测,42 名患者(33.9%)接受了连续一氧化碳记录。根据 CO 的变化,与使用 RFC 的患者相比,PLR 的假阳性率和假阴性率分别为 21.7% 和 36.8%,阳性预测值和阴性预测值分别为 70.6% 和 72.0%。根据 MAP 变化,与 RFC 相比,PLR 的假阳性率和假阴性率分别为 38.2% 和 43.3%,阳性预测值和阴性预测值分别为 64.4% 和 54.0%:本研究表明,在血流动力学受损的内科病人中,PLR 和 RFC 的一致性适中,在测试前负荷反应性时应考虑这一点。
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来源期刊
CiteScore
2.60
自引率
9.10%
发文量
93
审稿时长
6-12 weeks
期刊介绍: Medizinische Klinik – Intensivmedizin und Notfallmedizin is an internationally respected interdisciplinary journal. It is intended for physicians, nurses, respiratory and physical therapists active in intensive care and accident/emergency units, but also for internists, anesthesiologists, surgeons, neurologists, and pediatricians with special interest in intensive care medicine. Comprehensive reviews describe the most recent advances in the field of internal medicine with special focus on intensive care problems. Freely submitted original articles present important studies in this discipline and promote scientific exchange, while articles in the category Photo essay feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. In the rubric journal club well-respected experts comment on outstanding international publications. Review articles under the rubric "Continuing Medical Education" present verified results of scientific research and their integration into daily practice. The rubrics "Nursing practice" and "Physical therapy" round out the information.
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