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Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity–time integral through a subcostal view

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Abstract

Purpose

The passive leg raising test (PLR) produces a reversible increase in venous return and, if the patient’s ventricles are preload dependent, in the cardiac output. As this effect occurs in seconds, the transthoracic echocardiography is optimal for its real time assessment. The utility of the PLR for monitoring fluid responsiveness through the measurement of the left ventricle outflow tract velocity–time integral (LVOT VTI) in an apical 5-chamber view is well stablished. To achieve this view in critically ill patients is often challenging. The aim of this study is to explore the accuracy for predicting fluid responsiveness of the change in the right ventricle outflow tract velocity–time integral (RVOT VTI) from a subcostal view during a PLR.

Methods

This is a diagnostic accuracy study carried out in two centers in Argentina. We included patients admitted to the intensive care unit from January 2022 to April 2022, that required fluid expansion due to signs of tissular hypoperfusion. We measured the RVOT VTI from a subcostal view in a semi-recumbent position and during the PLR, and the LVOT VTI in an apical 5-chamber view before and after a fluid bolus. If the LVOT VTI increased by 15% after the fluid bolus, the patients were considered fluid responders.

Results

We included 43 patients. The area under the ROC curve for a change in the RVOT VTI during the PLR was 0.879 (95% CI 0.744–0.959). A change of 15.36% in the RVOT VTI with the PLR predicted fluid responsiveness with a sensitivity of 85.7% (95% CI 57.2%–98.2%) and specificity of 93.1% (95% CI 77.2–99.2). The positive predictive value was 85.7% (95% CI 60.8%–95.9%) and the negative predictive value was 93.1% (95% CI 78.8%–98%). The positive likelihood ratio was 12.43 and the negative predictive value was 0.15.

Conclusion

The RVOT VTI change during a PLR is suitable for the prediction of fluid responsiveness in critically ill patients.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Sanatorio De los Arcos, Juan B. Justo 909, CABA, Buenos Aires, Argentina

    Issac Cheong, Victoria Otero Castro & María Florencia Früchtenicht

  2. Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina

    Issac Cheong, Matías Brizuela, Pablo Martín Merlo & Francisco Marcelo Tamagnone

  3. Department of Critical Care Medicine, Sanatorio Privado del Interior SRL, Córdoba, Argentina

    Matías Brizuela

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  1. Issac Cheong
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  2. Victoria Otero Castro
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  3. Matías Brizuela
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  4. María Florencia Früchtenicht
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  5. Pablo Martín Merlo
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  6. Francisco Marcelo Tamagnone
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Contributions

conceptualization: IC; methodology: IC; formal analysis and investigation: IC, VOC, MB, MFF; writing—original draft preparation: IC; writing—review and editing: IC, VOC; supervision: IC, PMM, FMT.

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Correspondence to Issac Cheong.

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Conflict of interest

The authors have no relevant financial or non/financial interests to disclose.

Ethical approval

The study was conducted following the principles of the Helsinki Declaration and within the precautions established by ethical and legal standards. The study was approved by the Institutional Review Board and Ethic Committee of Clínica y Maternidad Suizo-Argentina (approval number 6517).

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Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 1, 2, and 3.

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Cheong, I., Otero Castro, V., Brizuela, M. et al. Passive leg raising test to predict fluid responsiveness using the right ventricle outflow tract velocity–time integral through a subcostal view. J Ultrasound (2022). https://doi.org/10.1007/s40477-022-00719-7

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