Assadi Farahnak
Department of Pediatrics, Rush University Medical Center, Section of Nephrology, Chicago, Illinois, USA.
Int J Prev Med. 2017 Jul 4;8:48. doi: 10.4103/ijpvm.IJPVM_11_17. eCollection 2017.
Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients.
Pertinent medical literature for fluid responsiveness in the critically ill patient published in English was searched over the past three decades, and then the search was extended as linked citations indicated.
Thirty-three studies including observational studies, randomized control trials, systemic review, and meta-analysis studies evaluating fluid responsiveness in the critically ill patient met selection criteria.
PLR coupled with real-time SV monitors is considered a simple, noninvasive, and accurate method to determine fluid responsiveness in critically ill patients with high sensitivity and specificity for a 10% increase in SV. The adverse effect of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function needs to be considered when choosing the type of fluid for resuscitation.
动态测量指标，即对液体负荷时每搏输出量（SV）的反应，已成功用于指导危重症患者的液体管理决策。然而，动态测量指标在预测心律失常、心室功能障碍患者或自主呼吸的危重症患者的液体反应性时往往不准确。被动抬腿（PLR）是一种简单的床旁操作，可能为指导低血容量危重症患者的液体复苏提供一种准确的替代方法。
检索过去三十年以英文发表的关于危重症患者液体反应性的相关医学文献，然后根据链接引用情况进行扩展检索。
33项研究符合入选标准，包括观察性研究、随机对照试验、系统评价和荟萃分析研究，这些研究评估了危重症患者的液体反应性。
PLR结合实时SV监测器被认为是一种简单、无创且准确的方法，用于确定危重症患者的液体反应性，对SV增加10%具有高敏感性和特异性。在选择复苏液体类型时，需要考虑白蛋白对颅脑外伤患者死亡率的不良影响以及富含氯的晶体液对死亡率和肾功能的影响。
