Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Level G Jarvis Building RMO, Infirmary Square, Leicester, LE1 5WW, UK.
Emergency Department, Kettering General Hospital, Kettering, UK.
BMC Emerg Med. 2022 Oct 26;22(1):172. doi: 10.1186/s12873-022-00721-6.
Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED).
We recruited adult patients planned to receive a resuscitation fluid bolus. Patients were monitored using a thoracic electrical bioimpedance (TEB) cardiac output monitor (Niccomo, Medis, Germany). A 3-min PLR was carried out before and after fluid infusion. Stroke volume changes (ΔSV) were calculated and a positive response was defined as ≥ 15% increase.
We recruited 39 patients, of which 37 were included into the analysis. The median age was 63 (50-77) years and 19 patients were females. 17 patients (46%) were fluid responders compared to 11 (30%) with positive response to PLR1. ΔSV with PLR1 and fluid bolus showed moderate correlation (r = 0.47, 95% confidence interval, CI 0.17-0.69) and 62% concordance rate. For the prediction of the response to a fluid bolus the PLR test had a sensitivity of 41% (95% CI 22-64) and specificity of 80% (95% CI 58-92) with an area under the curve of 0.59 (95% CI 0.41-0.78). None of the standard parameters showed a better predictive ability compared to PLR.
Using TEB, ΔSV with PLR showed a moderate correlation with fluid bolus, with a limited accuracy to predict fluid responsiveness. The PLR test was a better predictor of fluid responsiveness than the parameters commonly used in emergency care (such as heart rate and blood pressure). These data suggest the potential for a clinical trial in sepsis comparing TEB monitored, PLR directed fluid management with standard care.
被动抬腿（PLR）可作为一种可逆转的前负荷挑战，根据前负荷反应对患者进行分层。我们旨在评估非侵入性心输出量监测仪监测下的 PLR 在预测急诊（ED）患者液体复苏反应中的准确性。
我们招募了计划接受液体复苏的成年患者。患者使用胸部电阻抗（TEB）心输出量监测仪（Niccomo，Medis，德国）进行监测。在液体输注前后进行 3 分钟的 PLR。计算每搏量变化（ΔSV），并将≥15%的增加定义为阳性反应。
我们共招募了 39 名患者，其中 37 名患者纳入分析。患者的中位年龄为 63（50-77）岁，19 名患者为女性。17 名患者（46%）为液体反应者，而 PLR1 阳性反应者为 11 名（30%）。PLR1 和液体冲击后 ΔSV 呈中度相关（r=0.47，95%置信区间，CI 0.17-0.69），且符合率为 62%。对于液体冲击反应的预测，PLR 试验的敏感性为 41%（95%CI 22-64），特异性为 80%（95%CI 58-92），曲线下面积为 0.59（95%CI 0.41-0.78）。与 PLR 相比，没有一个标准参数显示出更好的预测能力。
使用 TEB，PLR 后的 ΔSV 与液体冲击呈中度相关，预测液体反应性的准确性有限。PLR 试验比急诊护理中常用的参数（如心率和血压）更能预测液体反应性。这些数据表明，在脓毒症患者中进行比较 TEB 监测、PLR 指导的液体管理与标准护理的临床试验具有潜力。
