PMID- 35842352 OWN - NLM STAT- MEDLINE DCOM- 20220824 LR - 20220826 IS - 1471-6771 (Electronic) IS - 0007-0912 (Linking) VI - 129 IP - 3 DP - 2022 Sep TI - Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study. PG - 308-316 LID - S0007-0912(22)00309-9 [pii] LID - 10.1016/j.bja.2022.04.031 [doi] AB - BACKGROUND: Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (DeltaPPV(PLR)) can also predict fluid responsiveness in mechanically ventilated patients. METHODS: In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether DeltaPPV(PLR) can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute DeltaPPV(PLR). RESULTS: Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6-7.6) ml kg(-1) ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute DeltaPPV(PLR) predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88-0.95; P<0.001) each. The grey zone for relative and absolute DeltaPPV(PLR) included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). CONCLUSIONS: Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. CLINICAL TRIAL REGISTRATION: NCT03225378. CI - Copyright (c) 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. FAU - Mallat, Jihad AU - Mallat J AD - Department of Critical Care Medicine, Arras Hospital, Arras, France; Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Normandy University, UNICAEN, Ecole Doctorale NBISE 497, Caen, France. Electronic address: mallatjihad@gmail.com. FAU - Fischer, Marc-Olivier AU - Fischer MO AD - Normandy University, UNICAEN, CHU de Caen Normandie, Ecole Doctorale NBISE 497, Service d'Anesthesie Reanimation, Caen, France. FAU - Granier, Maxime AU - Granier M AD - Department of Critical Care Medicine, Arras Hospital, Arras, France. FAU - Vinsonneau, Christophe AU - Vinsonneau C AD - Intensive Care Unit, Hopital de Bethune, Beuvry, France. FAU - Jonard, Marie AU - Jonard M AD - Department of Critical Care Medicine, Amiens University Medical Centre, Amiens, France. FAU - Mahjoub, Yazine AU - Mahjoub Y AD - Cardiac Vascular Thoracic and Respiratory Intensive Care Unit, Department of Anesthesia and Intensive Care, Amiens University Medical Centre, Amiens, France. FAU - Baghdadi, Fawzi Ali AU - Baghdadi FA AD - Department of Critical Care Medicine, Intensive Care Unit, Centre Hospitalier de Cambrai, Cambrai, France. FAU - Preau, Sebastien AU - Preau S AD - Division of Intensive Care, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, Lille, France. FAU - Poher, Fabien AU - Poher F AD - Intensive Care Unit, Centre Hospitalier de Boulogne Sur Mer, Boulogne Sur Mer, France. FAU - Rebet, Olivier AU - Rebet O AD - Cardiac Vascular Intensive Care Unit, Schaffner Hospital, Lens, France. FAU - Bouhemad, Belaid AU - Bouhemad B AD - Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France. FAU - Lemyze, Malcolm AU - Lemyze M AD - Department of Critical Care Medicine, Arras Hospital, Arras, France. FAU - Marzouk, Mehdi AU - Marzouk M AD - Intensive Care Unit, Hopital de Bethune, Beuvry, France. FAU - Besnier, Emmanuel AU - Besnier E AD - Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France. FAU - Hamed, Fadi AU - Hamed F AD - Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. FAU - Rahman, Nadeem AU - Rahman N AD - Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. FAU - Abou-Arab, Osama AU - Abou-Arab O AD - Anesthesia and Critical Care department, Amiens Hospital University, Amiens, France. FAU - Guinot, Pierre-Gregoire AU - Guinot PG AD - Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France; University of Burgundy and Franche-Comte, LNC UMR1231, Dijon, France. LA - eng SI - ClinicalTrials.gov/NCT03225378 PT - Journal Article PT - Multicenter Study PT - Observational Study DEP - 20220714 PL - England TA - Br J Anaesth JT - British journal of anaesthesia JID - 0372541 SB - IM MH - Blood Pressure MH - Cardiac Output MH - Critical Illness/therapy MH - *Fluid Therapy/methods MH - Hemodynamics MH - Humans MH - Leg MH - Prospective Studies MH - *Respiration, Artificial MH - Stroke Volume OTO - NOTNLM OT - acute circulatory failure OT - cardiac output OT - fluid challenge OT - grey zone OT - pulse pressure variation OT - sepsis EDAT- 2022/07/17 06:00 MHDA- 2022/08/25 06:00 CRDT- 2022/07/16 22:03 PHST- 2022/02/17 00:00 [received] PHST- 2022/04/15 00:00 [revised] PHST- 2022/04/17 00:00 [accepted] PHST- 2022/07/17 06:00 [pubmed] PHST- 2022/08/25 06:00 [medline] PHST- 2022/07/16 22:03 [entrez] AID - S0007-0912(22)00309-9 [pii] AID - 10.1016/j.bja.2022.04.031 [doi] PST - ppublish SO - Br J Anaesth. 2022 Sep;129(3):308-316. doi: 10.1016/j.bja.2022.04.031. Epub 2022 Jul 14.