Precision and consistency of the passive leg raising maneuver for determining fluid responsiveness with bioreactance non-invasive cardiac output monitoring in critically ill patients and healthy volunteers

English version

Autoři: Sahil Chopra ^aff001; Jordan Thompson ^aff002; Shahab Shahangian ^aff003; Suman Thapamagar ^aff001; Dafne Moretta ^aff001; Chris Gasho ^aff001; Avi Cohen ^aff001; H. Bryant Nguyen ^aff001
Působiště autorů: Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, California, United States of America ^aff001; School of Medicine, Loma Linda University, Loma Linda, California, United States of America ^aff002; Department of Medicine, Loma Linda University, Loma Linda, California, United States of America ^aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222956

Souhrn

Objective

The passive leg raising (PLR) maneuver has become standard practice in fluid resuscitation. We aim to investigate the precision and consistency of the PLR for determining fluid responsiveness in critically ill patients and healthy volunteers using bioreactance non-invasive cardiac output monitoring (NiCOM™, Cheetah Medical, Inc., Newton Center, Massachusetts, USA).

Methods

This study is prospective, single-center, observational cohort with repeated measures in critically ill patients admitted to the medical intensive care unit and healthy volunteers at a tertiary academic medical center. Three cycles of PLR were performed, each at 20–30 minutes apart. Fluid responsiveness was defined as a change in stroke volume index (ΔSVI) > 10% with each PLR as determined by NiCOM™. Precision was the variability in ΔSVI after the 3 PLR’s, and determined by range, average deviation and standard deviation. Consistency was the same fluid responsiveness determination of “Yes” (ΔSVI > 10%) or “No” (ΔSVI ≤ 10%) for all 3 PLR’s.

Results

Seventy-five patients and 25 volunteers were enrolled. In patients, the precision was range of 17.2±13.3%, average deviation 6.5±4.0% and standard deviation 9.0±5.2%; and for volunteers, 17.4±10.3%, 6.6±3.8% and 9.0±6.7%, respectively. There was no statistical difference in the precision measurements between patients and volunteers. Forty-nine (65.3%) patients vs. twenty-four (96.0%) volunteers had consistent results, p < 0.01. Among those with consistent results, twenty-four (49.0%) patients and 24 (100%) volunteers were fluid responsive.

Conclusions

The precision and consistency of determining ΔSVI with NiCOM™ after PLR may have clinical implication if ΔSVI > 10% is the absolute cutoff to determine fluid responsiveness.

Klíčová slova:

stroke – Resuscitation – Cardiology – Blood pressure – Catheters – Hemodynamics – Cardiac output – Heart rate

Zdroje

1. Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock: a retrospective pilot study. Chest. 2000;117(6):1749–54. doi: 10.1378/chest.117.6.1749 10858412.

2. National Heart L, Blood Institute Acute Respiratory Distress Syndrome Clinical Trials N, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75. doi: 10.1056/NEJMoa062200 16714767.

3. Kox M, Pickkers P. "Less is more" in critically ill patients: not too intensive. JAMA Intern Med. 2013;173(14):1369–72. doi: 10.1001/jamainternmed.2013.6702 23752755.

4. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486–552. doi: 10.1097/CCM.0000000000002255 28098591.

5. Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids? JAMA. 2016;316(12):1298–309. doi: 10.1001/jama.2016.12310 27673307.

6. Patterson SW, Starling EH. On the mechanical factors which determine the output of the ventricles. J Physiol. 1914;48(5):357–79. doi: 10.1113/jphysiol.1914.sp001669 16993262; PubMed Central PMCID: PMCPMC1420422.

7. Monnet X, Teboul JL. Passive leg raising. Intensive Care Med. 2008;34(4):659–63. doi: 10.1007/s00134-008-0994-y 18214429.

8. Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, et al. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials. Crit Care Med. 2016;44(5):981–91. doi: 10.1097/CCM.0000000000001556 26741579.

9. Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016;42(12):1935–47. doi: 10.1007/s00134-015-4134-1 26825952.

10. Benomar B, Ouattara A, Estagnasie P, Brusset A, Squara P. Fluid responsiveness predicted by noninvasive bioreactance-based passive leg raise test. Intensive Care Med. 2010;36(11):1875–81. doi: 10.1007/s00134-010-1990-6 20665001.

11. Raval NY, Squara P, Cleman M, Yalamanchili K, Winklmaier M, Burkhoff D. Multicenter evaluation of noninvasive cardiac output measurement by bioreactance technique. J Clin Monit Comput. 2008;22(2):113–9. doi: 10.1007/s10877-008-9112-5 18340540.

12. Squara P, Denjean D, Estagnasie P, Brusset A, Dib JC, Dubois C. Noninvasive cardiac output monitoring (NICOM): a clinical validation. Intensive Care Med. 2007;33(7):1191–4. doi: 10.1007/s00134-007-0640-0 17458538.

13. Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, et al. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med. 2010;36(9):1475–83. doi: 10.1007/s00134-010-1929-y 20502865.

14. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10. doi: 10.1007/bf01709751 8844239.

15. Huang CC, Tsai YH, Chen NH, Lin MC, Tsao TC, Lee CH, et al. Spontaneous variability of cardiac output in ventilated critically ill patients. Crit Care Med. 2000;28(4):941–6. doi: 10.1097/00003246-200004000-00005 10809263.

16. Sasse SA, Chen PA, Berry RB, Sassoon CS, Mahutte CK. Variability of cardiac output over time in medical intensive care unit patients. Crit Care Med. 1994;22(2):225–32. doi: 10.1097/00003246-199402000-00012 8306680.

17. Kupersztych-Hagege E, Teboul JL, Artigas A, Talbot A, Sabatier C, Richard C, et al. Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth. 2013;111(6):961–6. doi: 10.1093/bja/aet282 23985531.

18. Stetz CW, Miller RG, Kelly GE, Raffin TA. Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis. 1982;126(6):1001–4. doi: 10.1164/arrd.1982.126.6.1001 6758640.

19. Lamia B, Kim HK, Severyn DA, Pinsky MR. Cross-comparisons of trending accuracies of continuous cardiac-output measurements: pulse contour analysis, bioreactance, and pulmonary-artery catheter. J Clin Monit Comput. 2018;32(1):33–43. doi: 10.1007/s10877-017-9983-4 28188408.

20. Miller J, Ho CX, Tang J, Thompson R, Goldberg J, Amer A, et al. Assessing Fluid Responsiveness in Spontaneously Breathing Patients. Acad Emerg Med. 2016;23(2):186–90. doi: 10.1111/acem.12864 26764894.

21. Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32(3):691–9. doi: 10.1097/01.ccm.0000114996.68110.c9 15090949.