Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness

摘要: Passive leg raising (PLR) is a maneuver performed to test the cardiac Frank-Starling mechanism. We assessed influence of PLR-induced changes in preload on performance change pulse pressure (ΔPLRPP) and output (ΔPLRCO) for fluid responsiveness prediction. Sedated, nonarrhythmic patients with persistent shock were included this prospective multicenter study. Cardiac measured at baseline (patient supine), during PLR (lower limbs lifted 45°) after 500-ml volume expansion. Patients classified as responders or not. In whole population (n = 102), area under receiver-operating characteristic curve (AUC) was 0.76 ΔPLRPP higher ΔPLRCO (0.89)(p < 0.05), but likelihood ratios close 1. increase central venous (CVP) least 2 mmHg (n = 49), disclosed AUCs than rest (0.91 vs. 0.66 0.98 0.83; p < 0.05); positive/negative 9.3/0.14 (8% cutoff level) 30/0.07 (7% level), respectively. A CVP ≥2 mmHg required allow clinical usefulness PLR-derived indices. situation, well predicting deeply sedated patients.