Majunke Natascha, Philipp Dan, Weidhase Lorenz, Pasieka Bastian, Kunz Kevin, Seidel Frank, Scharm Robert, Petros Sirak
Interdisziplinäre Internistische Intensivmedizin, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Med Klin Intensivmed Notfmed. 2025 May;120(4):316-321. doi: 10.1007/s00063-024-01176-2. Epub 2024 Sep 6.
The passive leg raising (PLR) test is a simple test to detect preload responsiveness. However, variable fluid doses and infusion times were used in studies evaluating the effect of PLR. Studies showed that the effect of fluid challenge on hemodynamics dissipates in 10 min. This prospective study aimed to compare PLR and a rapid fluid challenge (RFC) with a 300-ml bolus infused within 5 min in adult patients with a hemodynamic compromise.
Critically ill medical patients with signs of systemic hypoperfusion were included if volume expansion was considered. Hemodynamic status was assessed with continuous measurements of cardiac output (CO), when possible, and mean arterial pressure (MAP) at baseline, during PLR, and after RFC.
A total of 124 patients with a median age of 65.0 years were included. Their acute physiology and chronic health evaluation (APACHE) II score was 19.7 ± 6.0, with a sequential organ failure assessment (SOFA) score of 9.0 ± 4.4. Sepsis was diagnosed in 73.3%, and 79.8% of the patients were already receiving a norepinephrine infusion. Invasive MAP monitoring was established in all patients, while continuous CO recording was possible in 42 patients (33.9%). Based on CO changes, compared with those with RFC, the false positive and false negative rates with PLR were 21.7 and 36.8%, respectively, with positive and negative predictive values of 70.6 and 72.0%, respectively. Based on MAP changes, compared with those with RFC, the false positive and false negative rates with PLR compared to RFC were 38.2% and 43.3%, respectively, with positive and negative predictive values of 64.4 and 54.0%, respectively.
This study demonstrated a moderate agreement between PLR and RFC in hemodynamically compromised medical patients, which should be considered when testing preload responsiveness.
被动抬腿（PLR）试验是检测前负荷反应性的一项简单试验。然而，在评估PLR效果的研究中，使用的液体剂量和输注时间各不相同。研究表明，液体冲击对血流动力学的影响在10分钟内就会消失。这项前瞻性研究旨在比较PLR和快速液体冲击（RFC，在5分钟内输注300ml推注液体）对血流动力学受损成年患者的影响。
纳入有全身灌注不足体征且考虑进行容量扩充的危重症内科患者。在可能的情况下，通过连续测量心输出量（CO）以及在基线、PLR期间和RFC后测量平均动脉压（MAP）来评估血流动力学状态。
共纳入124例患者，中位年龄为65.0岁。他们的急性生理与慢性健康状况评估（APACHE）II评分为19.7±6.0，序贯器官衰竭评估（SOFA）评分为9.0±4.4。73.3%的患者被诊断为脓毒症，79.8%的患者已经在接受去甲肾上腺素输注。所有患者均建立了有创MAP监测，42例患者（33.9%）能够连续记录CO。基于CO变化，与RFC组相比，PLR组的假阳性率和假阴性率分别为21.7%和36.8%，阳性预测值和阴性预测值分别为70.6%和72.0%。基于MAP变化，与RFC组相比，PLR组的假阳性率和假阴性率分别为38.2%和43.3%，阳性预测值和阴性预测值分别为64.4%和54.0%。
本研究表明，在血流动力学受损的内科患者中，PLR与RFC之间存在中度一致性，在检测前负荷反应性时应予以考虑。
