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. 2022 Oct 26;22(1):172.
doi: 10.1186/s12873-022-00721-6.

Can passive leg raise predict the response to fluid resuscitation in ED?

M H Elwan  1   2   3 , A Roshdy  4   5 , E M Elsharkawy  6 , S M Eltahan  6 , T J Coats  7
Affiliations

Can passive leg raise predict the response to fluid resuscitation in ED?

M H Elwan et al. BMC Emerg Med. .

Abstract

Objective: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Bioimpedance; Emergency; Fluid therapy; Haemodynamics; Non-invasive monitoring; Preload responsiveness.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overall haemodynamic changes. PLR, passive leg raise
Fig. 2
Fig. 2
Stroke volume changes classified by responsiveness to passive leg raise (PLR  + ve/-ve) and by fluid responsiveness (responders/non-responders)
Fig. 3
Fig. 3
Correlation between stroke volume changes (ΔSV) with fluid bolus and passive leg raise 1 (PLR1). One point is outside the axis limit. FR, fluid responsiveness
Fig. 4
Fig. 4
Receiver operator curve for the accuracy of baseline parameters in predicting fluid responsiveness. CO, cardiac output; EWS, early warning score; HR, heart rate; MAP, mean arterial pressure; SV, stroke volume; SBP, systolic blood pressure
See this image and copyright information in PMC

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