[Passive leg raising predicts volume responsiveness in patients with severe sepsis and septic shock].

ABSTRACT

OBJECTIVE: To evaluate the role of passive leg raising (PLR) test in predicting volume responsiveness in severe sepsis and septic shock patients. METHODS: Thirty severe sepsis and septic shock patients in intensive care unit (ICU) of Peking University Shenzhen Hospital were prospectively observed from February 2009 to January 2010. The hemodynamics including stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) were measured non invasively by ultrasonic cardiac output monitor (USCOM) device in the supine position, during PLR and after volume expansion (VE), and invasive arterial blood pressure and central venous pressure (CVP) were monitored consecutively. Responders were defined by the appearance of an increase in SV (ΔSV) ≥ 15% after VE. The role of PLR for predicting volume responsiveness was evaluated by receiver operating characteristic (ROC) curves. RESULTS: The CVP (cm H(2)O, 1 cm H(2)O=0.098 kPa) during PLR was increased compared with that at supine position in both responder group ( n =15) and non responder group ( n =15, 13.6 ± 6.6 vs. 12.1 ± 6.0, 11.9 ± 5.5 vs. 10.8 ± 5.2 , both P <0.01). ΔSV was higher in responder group than in non responder group during PLR [(16.6 ± 5.5)% vs. (3.8 ± 8.2)%, P=0.000].ΔSV during PLR was highly correlated to ΔSV after VE (r =0.681 , P =0.000).The area under the ROC curve (AUC) for PLR predicting volume responsiveness was 0.944 ± 0.039 ( P =0.000). The ΔSV>11% during PLR was found to predict volume responsiveness with a sensitivity of 86.7%, specificity of 93.3%, positive predictive value of 92.9% and negative predictive value of 87.5%. CONCLUSION: PLR can be used generally to predict volume responsiveness accurately in severe sepsis and septic shock patients, and it can be used to direct clinical practice.