Department of Anesthesiology and Intensive Care, Intensive Care Unit, Catholic University School of Medicine, Agostino Gemelli Hospital, Rome, Italy.
Intensive Care Med. 2010 Sep;36(9):1475-83. doi: 10.1007/s00134-010-1929-y. Epub 2010 May 26.
To systematically review the published evidence on the ability of passive leg raising-induced changes in cardiac output (PLR-cCO) and in arterial pulse pressure (PLR-cPP) to predict fluid responsiveness.
MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were screened. Clinical trials on human adults published as full-text articles in indexed journals were included. Two authors independently used a standardized form to extract data about study characteristics and results. Study quality was assessed by using the QUADAS scale.
Nine articles including a total of 353 patients were included in the final analysis. Data are reported as point estimate (95% confidence intervals). The pooled sensitivity and specificity of PLR-cCO were 89.4% (84.1-93.4%) and 91.4% (85.9-95.2%) respectively. Diagnostic odds ratio was 89.0 (40.2-197.3). The pooled area under the receiver operating characteristics curve (AUC) was 0.95 (0.92-0.97). The pooled correlation coefficient r between baseline value of PLR-cCO and CO increase after fluid load was 0.81 (0.75-0.86). The pooled difference in mean PLR-cCO values between responders and non-responders was 17.7% (13.6-21.8%). No significant differences were identified between patients adapted to ventilator versus those with inspiratory efforts nor between patients in sinus rhythm versus those with arrhythmias. The pooled AUC for PLR-cPP was 0.76 (0.67-0.86) and was significantly lower than the AUC for PLR-cCO (p < 0.001). The pooled difference in mean PLR-cPP values between responders and non-responders was 10.3% (6.5-14.1%).
Passive leg raising-induced changes in cardiac output can reliably predict fluid responsiveness regardless of ventilation mode and cardiac rhythm. PLR-cCO has a significantly higher predictive value than PLR-cPP.
系统回顾关于被动抬腿试验诱导的心输出量变化（PLR-cCO）和动脉脉搏压变化（PLR-cPP）预测液体反应性的能力的已发表证据。
筛选 MEDLINE、EMBASE 和 Cochrane 系统评价数据库。纳入在索引期刊上以全文形式发表的关于成人的临床试验。两位作者独立使用标准化表格提取研究特征和结果的数据。使用 QUADAS 量表评估研究质量。
9 篇文章（共 353 例患者）最终纳入分析。数据以点估计值（95%置信区间）表示。PLR-cCO 的汇总敏感性和特异性分别为 89.4%（84.1-93.4%）和 91.4%（85.9-95.2%）。诊断优势比为 89.0（40.2-197.3）。受试者工作特征曲线下面积（AUC）的汇总值为 0.95（0.92-0.97）。PLR-cCO 基线值与液体负荷后 CO 增加之间的汇总相关系数 r 为 0.81（0.75-0.86）。有反应者和无反应者之间的平均 PLR-cCO 值差异为 17.7%（13.6-21.8%）。在适应呼吸机的患者与有吸气努力的患者之间，以及在窦性节律患者与心律失常患者之间，均未发现显著差异。PLR-cPP 的汇总 AUC 为 0.76（0.67-0.86），显著低于 PLR-cCO 的 AUC（p < 0.001）。有反应者和无反应者之间的平均 PLR-cPP 值差异为 10.3%（6.5-14.1%）。
无论通气模式和心律如何，被动抬腿试验诱导的心输出量变化都可以可靠地预测液体反应性。PLR-cCO 的预测价值显著高于 PLR-cPP。
