Fluid Responsiveness Assessment Using Passive Leg Raising Test to Reduce Fluid Administration and Weight Gain in Patients with Septic Shock

Abstract

Background: Several observational studies have demonstrated an association between fluid accumulation and mortality in sepsis. Our aim was to determine if assessment of fluid responsiveness by a passive leg raising (PLR) algorithm could reduce fluid accumulation after 3 days in the intensive care unit (ICU) in patients with septic shock. Methods: This was an open-label single-centre randomised clinical trial performed in a surgical ICU in a tertiary centre in Stockholm, Sweden. We randomised adult (>18 years) patients with septic shock admitted to the ICU to a PLR group or a standard of care group. An increase in stroke volume index of at least 10% on the PLR test was required for the clinician to administer a fluid bolus to patients in the PLR group.  Results: We randomised 34 patients. The mean (SD) weight gain after three full ICU-days was 0.6 ± 3.2 kg in the PLR group and 1.3 ± 3.9 kg in the control group (P = 0.59). The median (IQR) amount of administered resuscitation fluid during the study period was 2103 (1283-2645) ml in the PLR group and 2408 (954-5045) ml in the control group (P = 0.38). We could implement a protocol that required a positive PLR-test before administration of resuscitation fluids, but recruitment rate was low. The trial was terminated early for futility.  Conclusion: The PLR protocol was not meaningful in our clinical setting, as weight gain was already low in the control group. To increase feasibility of a trial which implements a PLR-test we recommend using a non-invasive hemodynamic measurement, to include restriction of maintenance fluids in the protocol and to investigate the level of weight gain in the setting where the trial is to be performed before the start of the trial. (Funded by Stockholm County Council; ClinicalTrials.gov number, NCT02301585.)    Citation:  Maria Cronhjort, Magnus Bergman, Eva Joelsson-Alm, Mona-Britt Divander, Emma Jerkegren, Anca Balintescu, et al. Fluid Responsiveness Assessment Using Passive Leg Raising Test to Reduce Fluid Administration and Weight Gain in Patients with Septic Shock. J Anesth Perioper Med 2017; 4 : 169-78. doi: 10.24015/ JAPM.2017.0049 This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.