Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials

被引:165
作者
Cherpanath, Thomas G. V. [1 ]
Hirsch, Alexander [2 ]
Geerts, Bart F. [3 ]
Lagrand, Wim K. [1 ]
Leeflang, Mariska M. [4 ]
Schultz, Marcus J. [5 ]
Groeneveld, A. B. Johan [6 ]
机构
[1] Univ Amsterdam, Acad Med Ctr, Dept Intens Care Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Cardiol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Dept Anesthesiol, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[4] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol Biostat & Bioinformat, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[5] Univ Amsterdam, Acad Med Ctr, LEICA, Dept Intens Care Med, Meibergdreef 9, NL-1105 AZ Amsterdam, Netherlands
[6] Erasmus Univ, Med Ctr, Dept Intens Care Med, Rotterdam, Netherlands
关键词
fluid challenge; fluid responsiveness; hemodynamic monitoring; meta-analysis; passive leg raising; PULSE PRESSURE VARIATION; DIAGNOSTIC-TEST ACCURACY; CRITICALLY-ILL PATIENTS; SPONTANEOUSLY BREATHING PATIENTS; END-EXPIRATORY OCCLUSION; STROKE VOLUME VARIATIONS; NONINVASIVE ASSESSMENT; ARTERIAL-PRESSURE; PUBLICATION BIAS; CARDIAC-OUTPUT;
D O I
10.1097/CCM.0000000000001556
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: Passive leg raising creates a reversible increase in venous return allowing for the prediction of fluid responsiveness. However, the amount of venous return may vary in various clinical settings potentially affecting the diagnostic performance of passive leg raising. Therefore we performed a systematic meta-analysis determining the diagnostic performance of passive leg raising in different clinical settings with exploration of patient characteristics, measurement techniques, and outcome variables. Data Sources: PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and citation tracking of relevant articles. Study Selection: Clinical trials were selected when passive leg raising was performed in combination with a fluid challenge as gold standard to define fluid responders and non-responders. Data Extraction: Trials were included if data were reported allowing the extraction of sensitivity, specificity, and area under the receiver operating characteristic curve. Data Synthesis: Twenty-three studies with a total of 1,013 patients and 1,034 fluid challenges were included. The analysis demonstrated a pooled sensitivity of 86% (95% CI, 79-92), pooled specificity of 92% (95% CI, 88-96), and a summary area under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.98). Mode of ventilation, type of fluid used, passive leg raising starting position, and measurement technique did not affect the diagnostic performance of passive leg raising. The use of changes in pulse pressure on passive leg raising showed a lower diagnostic performance when compared with passive leg raising induced changes in flow variables, such as cardiac output or its direct derivatives (sensitivity of 58% [95% CI, 44-70] and specificity of 83% [95% CI, 68-92] vs sensitivity of 85% [95% CI, 78-90] and specificity of 92% [95% CI, 87-94], respectively; p < 0.001). Conclusions: Passive leg raising retains a high diagnostic performance in various clinical settings and patient groups. The predictive value of a change in pulse pressure on passive leg raising is inferior to a passive leg raising induced change in a flow variable.
引用
收藏
页码:981 / 991
页数:11
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