Passive leg raising predicts volume responsiveness in patients with septic shock / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the hemodynamic response to passive leg raising (PLR) indicates fluid responsiveness in patients with septic shock.</p><p><b>METHODS</b>Twenty patients with septic shock, considered for fluid challenge (FC), were enrolled in the study from June 2009 to May 2010. Hemodynamic changes were determined by pulse-contour derived cardiac index at baseline, before and after PLR, return to baseline for 10 min, before and after fluid challenge (250 ml saline for 10 min). An increase of SV after fluid challenge (FC-&Delta;SV) ≥ 10% were defined responders.</p><p><b>RESULTS</b>Twenty patients with septic shock were included in the study. PLR and fluid challenge were performed 46 instances, among which 15 instances were defined as response group. SV and pulse pressure induced by PLR (PLR-&Delta;SV and PLR-&Delta;PP) were increased significantly in response group [(76 ± 19) ml vs. (65 ± 18) ml, (73 ± 20) mmHg vs. (62 ± 20) mmHg (1 mmHg = 0.133 kPa), P < 0.05], while in nonresponse group there were no significant change. PLR-&Delta;SV and PLR-&Delta;PP were correlated with FC-&Delta;SV (r = 0.51, P = 0.001; r = 0.45, P = 0.006), central venous pressure (CVP) were unrelated with FC-&Delta;SV. Area under curve (AUC) for PLR-&Delta;SV, PLR-&Delta;PP and stroke volume variation (SVV) were 0.846, 0.791 and 0.708. PLR-&Delta;SV ≥ 12.5% predicted fluid responsiveness with sensitivity of 80% and specificity of 93.5%. PLR-&Delta;PP ≥ 9.5% predicted fluid responsiveness with sensitivity of 73.3% and specificity of 83.9%.</p><p><b>CONCLUSIONS</b>PLR-&Delta;SV and PLR-&Delta;PP can predict fluid responsiveness in patients with septic shock. PLR-&Delta;SV and PLR-&Delta;PP have a greater ability in predicting volume responsiveness than CVP and SVV.</p>