Changes in the Cardiac Index Induced by Unilateral Passive Leg Raising in Spontaneously Breathing Patients: A Novel Way to Assess Fluid Responsiveness

Zhiyong Zhao; Zhongwei Zhang; Qionghua Lin; Lihua Shen; Pengmei Wang; Shan Zhang; Zhili Xia; Fangfang Li; Qian Xing; Biao Zhu

doi:10.3389/fmed.2022.862226

Changes in the Cardiac Index Induced by Unilateral Passive Leg Raising in Spontaneously Breathing Patients: A Novel Way to Assess Fluid Responsiveness

Front Med (Lausanne). 2022 Apr 11:9:862226. doi: 10.3389/fmed.2022.862226. eCollection 2022.

Authors

Zhiyong Zhao^{1

2}, Zhongwei Zhang^{1

2}, Qionghua Lin^{1

2}, Lihua Shen^{1

2}, Pengmei Wang^{1

2}, Shan Zhang^{1

2}, Zhili Xia^{1

2}, Fangfang Li^{1

2}, Qian Xing^{1

2}, Biao Zhu^{1

2}

Affiliations

¹ Department of Critical Care, Fudan University Shanghai Cancer Center, Shanghai, China.
² Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Abstract

Background: Evaluation of fluid responsiveness in intensive care unit (ICU) patients is crucial. This study was to determine whether changes in the cardiac index (CI) induced by a unilateral passive leg raising (PLR) test in spontaneously breathing patients can estimate fluid responsiveness.

Methods: This was a prospective study, and 40 patients with spontaneous breathing activity who were considered for volume expansion (VE) were included. CI data were obtained in a semirecumbent position, during unilateral PLR, bilateral PLR, and immediately after VE. If the CI increased more than 15% in response to the expansion in volume, patients were defined as responders.

Results: The results showed that a unilateral PLR-triggered CI increment of ≥7.5% forecasted a fluid-triggered CI increment of ≥15% with 77.3% sensitivity and 83.3% specificity with and an area under the receiver operating characteristic (ROC) curve of 0.82 [P < 0.001]. Compared with that for bilateral PLR, the area under the ROC curve constructed for unilateral PLR-triggered changes in CI (ΔCI) was not significantly different (p = 0.1544).

Conclusion: ΔCI >7.5% induced by unilateral PLR may be able to predict fluid responsiveness in spontaneously breathing patients and is not inferior to that induced by bilateral PLR.

Trial registration: Unilateral passive leg raising test to assess patient volume responsiveness: Single-Center Clinical Study, ChiCTR2100046762. Registered May 28, 2021.

Keywords: cardiac index; fluid responsiveness; leg raising; pulse contour; volume expansion.