Julien Maizel1,2, Norair Airapetian1, Emmanuel Lorne2, Christophe Tribouilloy2, Ziad Massy2, Michel Slama3,4. 1. Unite de Reanimation Medicale, Service de Nephrologie, CHU Sud, 80054 cedex 1, Amiens, France. 2. INSERM, ERI 12, Amiens, France. 3. Unite de Reanimation Medicale, Service de Nephrologie, CHU Sud, 80054 cedex 1, Amiens, France. slama.michel@chu-amiens.fr. 4. INSERM, ERI 12, Amiens, France. slama.michel@chu-amiens.fr.
Abstract
OBJECTIVE: Suspected central hypovolemia is a frequent clinical situation in hospitalized patients, and no simple bedside diagnostic test in spontaneously breathing patients is available. We tested the value of passive leg raising to predict hemodynamic improvement after fluid expansion in patients with suspected central hypovolemia. DESIGN AND SETTING: Prospective study in four intensive care units at the Amiens university hospital. Thirty-four spontaneously breathing patients with suspected hypovolemia were included and were classified as responders (cardiac output increased by 12% or more after fluid expansion) or nonresponders. Patients were analyzed in the supine position during 30 degrees leg raising and after fluid expansion. MEASUREMENTS AND RESULTS: Stroke volume and cardiac output determined by echocardiographic and Doppler techniques and heart rate and blood pressure were measured at baseline, during passive leg raising and after fluid expansion. An increase of cardiac output or stroke volume by 12% or more during passive leg raising was highly predictive of central hypovolemia (AUC 0.89+/-0.06, 95% CI 0.73-0.97 for cardiac output and AUC 0.9+/-0.06, 95% CI 0.74-0.97 for stroke volume). Sensitivity and specificity values were 63% and 89% for cardiac output and 69%, 89% for stroke volume respectively. A close correlation (r=0.75; p<0.0001) was observed between cardiac output changes during leg raising and changes in cardiac output after fluid expansion. CONCLUSIONS: Bedside measurement of cardiac output or stroke volume by Doppler techniques during passive leg raising was predictive of a positive hemodynamic effect of fluid expansion in spontaneously breathing patients with suspected central hypovolemia.
OBJECTIVE: Suspected central hypovolemia is a frequent clinical situation in hospitalized patients, and no simple bedside diagnostic test in spontaneously breathing patients is available. We tested the value of passive leg raising to predict hemodynamic improvement after fluid expansion in patients with suspected central hypovolemia. DESIGN AND SETTING: Prospective study in four intensive care units at the Amiens university hospital. Thirty-four spontaneously breathing patients with suspected hypovolemia were included and were classified as responders (cardiac output increased by 12% or more after fluid expansion) or nonresponders. Patients were analyzed in the supine position during 30 degrees leg raising and after fluid expansion. MEASUREMENTS AND RESULTS:Stroke volume and cardiac output determined by echocardiographic and Doppler techniques and heart rate and blood pressure were measured at baseline, during passive leg raising and after fluid expansion. An increase of cardiac output or stroke volume by 12% or more during passive leg raising was highly predictive of central hypovolemia (AUC 0.89+/-0.06, 95% CI 0.73-0.97 for cardiac output and AUC 0.9+/-0.06, 95% CI 0.74-0.97 for stroke volume). Sensitivity and specificity values were 63% and 89% for cardiac output and 69%, 89% for stroke volume respectively. A close correlation (r=0.75; p<0.0001) was observed between cardiac output changes during leg raising and changes in cardiac output after fluid expansion. CONCLUSIONS: Bedside measurement of cardiac output or stroke volume by Doppler techniques during passive leg raising was predictive of a positive hemodynamic effect of fluid expansion in spontaneously breathing patients with suspected central hypovolemia.
Authors: F Michard; S Boussat; D Chemla; N Anguel; A Mercat; Y Lecarpentier; C Richard; M R Pinsky; J L Teboul Journal: Am J Respir Crit Care Med Date: 2000-07 Impact factor: 21.405
Authors: M A Slama; A Novara; P Van de Putte; B Diebold; A Safavian; M Safar; M Ossart; J Y Fagon Journal: Intensive Care Med Date: 1996-09 Impact factor: 17.440
Authors: F Michard; D Chemla; C Richard; M Wysocki; M R Pinsky; Y Lecarpentier; J L Teboul Journal: Am J Respir Crit Care Med Date: 1999-03 Impact factor: 21.405
Authors: Xavier Monnet; Mario Rienzo; David Osman; Nadia Anguel; Christian Richard; Michael R Pinsky; Jean-Louis Teboul Journal: Crit Care Med Date: 2006-05 Impact factor: 7.598
Authors: A Lafanechère; F Pène; C Goulenok; A Delahaye; V Mallet; G Choukroun; J D Chiche; J P Mira; A Cariou Journal: Crit Care Date: 2006 Impact factor: 9.097
Authors: Julien Pottecher; Stéphane Deruddre; Jean-Louis Teboul; Jean-François Georger; Christian Laplace; Dan Benhamou; Eric Vicaut; Jacques Duranteau Journal: Intensive Care Med Date: 2010-08-20 Impact factor: 17.440
Authors: Fabio Cavallaro; Claudio Sandroni; Cristina Marano; Giuseppe La Torre; Alice Mannocci; Chiara De Waure; Giuseppe Bello; Riccardo Maviglia; Massimo Antonelli Journal: Intensive Care Med Date: 2010-05-26 Impact factor: 17.440
Authors: Vincent Caille; Julien Jabot; Guillaume Belliard; Cyril Charron; François Jardin; Antoine Vieillard-Baron Journal: Intensive Care Med Date: 2008-03-20 Impact factor: 17.440
Authors: Massimo Antonelli; Elie Azoulay; Marc Bonten; Jean Chastre; Giuseppe Citerio; Giorgio Conti; Daniel De Backer; François Lemaire; Herwig Gerlach; Johan Groeneveld; Goran Hedenstierna; Duncan Macrae; Jordi Mancebo; Salvatore M Maggiore; Alexandre Mebazaa; Philipp Metnitz; Jerme Pugin; Jan Wernerman; Haibo Zhang Journal: Intensive Care Med Date: 2008-01-31 Impact factor: 17.440
Authors: Matthieu Biais; Lionel Vidil; Philippe Sarrabay; Vincent Cottenceau; Philippe Revel; François Sztark Journal: Crit Care Date: 2009-12-07 Impact factor: 9.097