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Vol. 43. Num. 1.
Pages 1-60 (January - February 2019)
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Vol. 43. Num. 1.
Pages 1-60 (January - February 2019)
Original article
DOI: 10.1016/j.medine.2017.11.004
Ultrasound stroke volume variation induced by passive leg raising and fluid responsiveness: An observational cohort study
Variación ultrasónica del volumen sistólico inducida por la elevación pasiva de la pierna y la respuesta de fluidos: estudio de cohortes observacional
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A. Trifia,b,
Corresponding author
ahlem.ahurabta@gmail.com

Corresponding author.
, S. Abdellatifa,b, F. Dalya,b, R. Nasria,b, Y. Touila,b, S. Ben Lakhala,b
a Medical Intensive Care Unit, University Hospital Center La Rabta, Tunis, Tunisia
b Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
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Tables (3)
Table 1. Patient characteristics.
Table 2. Initial hemodynamic parameters taken in stage one.
Table 3. Hemodynamic parameters taken throughout the four stages of measurement (results expressed in mean±SD).
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Abstract
Objective

To assess the performance of the ultrasound measurement of stroke volume (SV) coupled to passive leg raising (PLR) in predicting fluid responsiveness (FR).

Design

A prospective cohort study was carried out in patients requiring volume expansion (VE). A transthoracic Doppler echocardiography (TTE) device was used for the measurement of SV. Four measurements were obtained: before and 90s after PLR, and before and after VE. The patients were subsequently classified according to their hemodynamic response to VE. Responders were defined by an increase in SV of at least 15% in response to VE.

Results

Thirty maneuvers were studied. An increase in SV>15% in response to PLR was recorded in 21 cases. Hemodynamic indices taken in the first stage showed significant differences in the distensibility index of the inferior vena cava (dIVC), in the velocity-time integral of aortic blood flow (VTIAo) and in SV, with respective p-values of 0.009, 0.012 and 0.025. The SV changes induced by VE were significantly correlated to the SV changes induced by PLR, with a Spearman coefficient of 0.77 and a linear equation y=0.82 x+1.68. Fluid responsiveness can be efficiently predicted by assessing the effects of PLR on SV monitored by Doppler TTE, with a sensitivity of 94.7% and a negative predictive value of 88%.

Conclusion

Our data support the interest of Doppler TTE as an effective tool in predicting FR through the assessment of SV in response to PLR, in hemodynamically unstable patients.

Keywords:
Stroke volume
Passive leg raising
Volume expansion
Echocardiography
Fluid responsiveness
Abbreviations:
VE
SV
FR
PLR
ICU
CO
EE
MAP
VTIAo
LVEF
IVC
dIVC
ROC
IQR
SAPS
SOFA
PEEP
HR
cIVC
SBP
AUC
CVP
EVLA
PAC
PPV
NPV
Resumen
Objetivo

Evaluar el rendimiento de la medida del volumen sistólico (VS) por ultrasonido junto con la elevación pasiva de piernas (EPP) para predecir la respuesta de fluidos (RF).

Diseño

Estudio prospectivo de cohorte realizado en pacientes que requieren expansión de volumen (EV). Se utilizó un dispositivo doppler ecocardiográfico transtorácico (ETT) para la medición del VS. Se obtuvieron 4 mediciones: antes y 90s después de la EPP, y antes y después de la EV. Posteriormente, los pacientes se clasificaron según su respuesta hemodinámica a VE. Los respondedores se definieron por un aumento del VS de al menos 15% en respuesta a EV.

Resultados

Se estudiaron 30 maniobras. Un aumento del VS>15% en respuesta a la EPP se informó en 21 casos. Los índices hemodinámicos tomados en la primera etapa mostraron diferencias significativas en el índice de distensibilidad de la vena cava inferior (dVCI), en la integral velocidad-tiempo del flujo sanguíneo aórtico (IVTAo) y en el VS con valores p respectivos en 0,009, 0,012 y 0,025. Los cambios del VS inducidos por EV se correlacionaron significativamente con los cambios del VS inducidos por EPP con un coeficiente de Spearman en 0,77 y una ecuación lineal en y=0,82× +1,68. La respuesta de fluidos se puede predecir eficazmente mediante la evaluación de los efectos de EPP en el VS vigilado por ETT-doppler con sensibilidad en el 94,7% y VPN en el 88%.

Conclusión

Nuestros datos respaldan el interés del ETT-doppler como una herramienta eficaz en la predicción de la RF por la evaluación del VS en respuesta a la EPP en pacientes hemodinámicamente inestables.

Palabras clave:
Volumen sistólico
Elevación pasiva de las piernas
Expansión volumétrica
Ecocardiografía
Capacidad de respuesta

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