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Passive leg raising test using the carotid flow velocity–time integral to predict fluid responsiveness

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Abstract

Purpose

The passive leg raising test (PLR) is a noninvasive method widely adopted to assess fluid responsiveness. We propose to explore if changes in the carotid flow assessed by echo-Doppler can predict fluid responsiveness after a PLR.

Methods

We conducted a performance diagnostic study in two intensive care units from Argentina between February and April 2022. We included patients with signs of tissular hypoperfusion that required fluid resuscitation. We labeled the patients as fluid responders when we measured, after a fluid bolus, an increase greater than 15% in the left ventricle outflow tract (LVOT) VTI in an apical 5-chamber view and we compared those results with the carotid flow (CF) velocity–time integral (VTI) from the left supraclavicular region in a semi-recumbent position and during the PLR.

Results

Of the 62 eligible patients, 50 patients (80.6%) were included. The area under the ROC curve for a change in CF VTI during the PLR test was 0.869 (95% CI 0.743–0.947). An increase of at least of 11% in the CF VTI with the PLR predicted fluid-responsiveness with a sensitivity of 77.3% (95% CI 54.6–92.2%) and specificity of 78.6% (95% CI 59–91.7%). The positive predictive value was 73.9% (95% CI 57.4–85.6%) and the negative predictive value was 81.5% (95% CI 66.5–90.7%). The positive likelihood ratio was 3.61 and the negative likelihood ratio was 0.29.

Conclusion

An increase greater than 11% in CF VTI after a PLR may be useful to predict fluid responsiveness among critically ill patients.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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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, Fernando Ariel Sosa, Francisco Marcelo Tamagnone & Pablo Martín Merlo

  3. Department of Critical Care Medicine, Hospital Alemán, Buenos Aires, Argentina

    Fernando Ariel Sosa & Bárbara Tort Oribe

Authors
  1. Issac Cheong
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  2. Victoria Otero Castro
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  3. Fernando Ariel Sosa
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  4. Bárbara Tort Oribe
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  5. María Florencia Früchtenicht
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  6. Francisco Marcelo Tamagnone
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  7. Pablo Martín Merlo
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Contributions

Conceptualization: IC; Methodology: IC; Formal analysis: IC; Investigation: IC, VOC, FAS, BTO, MFF; Writing—original draft preparation: IC; Writing—review and editing: IC, VOC; Supervision: IC, FMT, PMM.

Corresponding author

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 6598).

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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, 3, and 4

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Cheong, I., Otero Castro, V., Sosa, F.A. et al. Passive leg raising test using the carotid flow velocity–time integral to predict fluid responsiveness. J Ultrasound 27, 97–104 (2024). https://doi.org/10.1007/s40477-023-00824-1

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  • DOI: https://doi.org/10.1007/s40477-023-00824-1

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