Intensive Care Medicine

, Volume 33, Issue 7, pp 1125–1132 | Cite as

Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity

  • Bouchra Lamia
  • Ana Ochagavia
  • Xavier Monnet
  • Denis Chemla
  • Christian Richard
  • Jean-Louis Teboul
Original

Abstract

Objective

In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsiveness is a difficult challenge since the respiratory variation in arterial pressure cannot be used. Our objective was to test whether volume responsiveness can be predicted by the response of stroke volume measured with transthoracic echocardiography to passive leg raising in patients with spontaneous breathing activity. We also examined whether common echocardiographic indices of cardiac filling status are valuable to predict volume responsiveness in this category of patients.

Design and setting

Prospective study in the medical intensive care unit of a university hospital.

Patients

24 patients with spontaneously breathing activity considered for volume expansion.

Measurements

We measured the response of the echocardiographic stroke volume to passive leg raising and to saline infusion (500 ml over 15 min). The left ventricular end-diastolic area and the ratio of mitral inflow E wave velocity to early diastolic mitral annulus velocity (E/Ea) were also measured before and after saline infusion.

Results

A passive leg raising induced increase in stroke volume of 12.5% or more predicted an increase in stroke volume of 15% or more after volume expansion with a sensitivity of 77% and a specificity of 100%. Neither left ventricular end-diastolic area nor E/Ea predicted volume responsiveness.

Conclusions

In our critically ill patients with spontaneous breathing activity the response of echocardiographic stroke volume to passive leg raising was a good predictor of volume responsiveness. On the other hand, the common echocardiographic markers of cardiac filling status were not valuable for this purpose.

Keywords

Volume responsiveness Passive leg raising Stroke volume Echocardiography Cardiac preload Spontaneous breathing 

References

  1. 1.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  2. 2.
    Preisman S, Kogan S, Berkenstadt H, Perel A (2005) Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the respiratory systolic variation test and static preload indicators. Br J Anaesth 95:746–755PubMedCrossRefGoogle Scholar
  3. 3.
    Pinsky MR, Payen D (2005) Functional hemodynamic monitoring. Crit Care 9:566–572PubMedCrossRefGoogle Scholar
  4. 4.
    Magder S (2004) Clinical usefulness of respiratory variations in arterial pressure. Am J Respir Crit Care Med 169:151–155PubMedCrossRefGoogle Scholar
  5. 5.
    Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407PubMedCrossRefGoogle Scholar
  6. 6.
    Heenen S, De Backer D, Vincent JL (2006) How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care 10:R102PubMedCrossRefGoogle Scholar
  7. 7.
    Perner A, Faber T (2006) Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand 50:1068–1077PubMedCrossRefGoogle Scholar
  8. 8.
    Joseph MX, Disney PJ, Da Costa R, Hutchison SJ (2004) Transthoracic echocardiography to identify or exclude cardiac cause of shock. Chest 126:1592–1597PubMedCrossRefGoogle Scholar
  9. 9.
    Huntsman LL, Stewart DK, Barnes SR, Franklin SB, Colocousis JS, Hessel EA (1983) Noninvasive Doppler determination of cardiac output in man. Clinical validation. Circulation 67:593–602PubMedGoogle Scholar
  10. 10.
    Thys DM, Hillel Z, Goldman ME, Mindich BP, Kaplan JA (1987) A comparison of hemodynamic indices derived by invasive monitoring and two-dimensional echocardiography. Anesthesiology 67:630–634PubMedCrossRefGoogle Scholar
  11. 11.
    Coriat P, Vrillon M, Perel A, Baron JF, Le Bret F, Saada M, Viars P (1994) A comparison of systolic blood pressure variations and echocardiographic estimates of end-diastolic left ventricular size in patients after aortic surgery. Anesth Analg 78:46–53PubMedCrossRefGoogle Scholar
  12. 12.
    Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533PubMedCrossRefGoogle Scholar
  13. 13.
    Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures. A comparative simultaneous Doppler catheterization study. Circulation 102:1788–1794PubMedGoogle Scholar
  14. 14.
    Coudray A, Romand JA, Treggiari M, Bendjelid K (2005) Fluid responsiveness in spontaneously breathing patients: A review of indexes used in intensive care. Crit Care Med 33:2757–2762PubMedCrossRefGoogle Scholar
  15. 15.
    Thomas M, Shillingford J (1965) The circulatory response to a standard postural change in ischaemic heart disease. Br Heart J 27:17–27PubMedGoogle Scholar
  16. 16.
    De Hert SG, Robert D, Cromheecke S, Michard F, Nijs J, Rodrigus IE (2006) Evaluation of left ventricular function in anesthetized patients using femoral artery dP/dt (max). J Cardiothorac Vasc Anesth 20:325–330PubMedCrossRefGoogle Scholar
  17. 17.
    Teboul JL, Monnet X, Richard C (2005) Arterial pulse pressure variation during positive pressure ventilation and passive leg raising. In: Pinsky MR, Payen D (eds) Functional hemodynamic monitoring, 1st edn. Springer, Berlin Heidelberg New York, pp 331–343Google Scholar
  18. 18.
    Reich DL, Konstadt SN, Raissi S, Hubbard M, Thys DM (1989) Trendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery disease. Crit Care Med 17:313–317PubMedCrossRefGoogle Scholar
  19. 19.
    Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G (2002) Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 121:1245–1252PubMedCrossRefGoogle Scholar
  20. 20.
    Lafanechere A, Pene F, Goulenok C, Delahaye A, Mallet V, Choukroun G, Chiche J, Mira J, Cariou A (2006) Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients. Crit Care 10:R132PubMedCrossRefGoogle Scholar
  21. 21.
    Cheung AT, Savino JS, Weiss SJ, Aukburg SJ, Berlin JA (1994) Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function. Anesthesiology 81:376–387PubMedCrossRefGoogle Scholar
  22. 22.
    Lattik R, Couture P, Denault AY, Carrier M, Harel F, Taillefer J, Tardif JC (2002) Mitral Doppler indices are superior to two-dimensional echocardiographic and hemodynamic variables in predicting responsiveness of cardiac output to a rapid intravenous infusion of colloid. Anesth Analg 94:1092–1099PubMedCrossRefGoogle Scholar
  23. 23.
    Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis induced hypotension. Anesthesiology 89:1313–1321PubMedCrossRefGoogle Scholar
  24. 24.
    Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873PubMedCrossRefGoogle Scholar
  25. 25.
    Nagueh SF (1999) Noninvasive evaluation of hemodynamics by Doppler echocardiography. Curr Opin Cardiol 14:217–224PubMedCrossRefGoogle Scholar
  26. 26.
    Sohn DW, Song JM, Zo JH, Chai IH, Kim HS, Chun HG, Kim HC (1999) Mitral annulus velocity in the evaluation of left ventricular diastolic function in atrial fibrillation. J Am Soc Echocardiogr 12:927–931PubMedCrossRefGoogle Scholar
  27. 27.
    Bouhemad B, Nicolas-Robin A, Benois A, Lemaire S, Goarin JP, Rouby JJ (2003) Echocardiographic Doppler assessment of pulmonary capillary wedge pressure in surgical patients with postoperative circulatory shock and acute lung injury. Anesthesiology 98:1091–1100PubMedCrossRefGoogle Scholar
  28. 28.
    Combes A, Arnoult F, Trouillet JL (2004) Tissue Doppler imaging estimation of pulmonary artery occlusion pressure in ICU patients. Intensive Care Med 30:75–81PubMedCrossRefGoogle Scholar
  29. 29.
    Firstenberg MS, Levine BD, Garcia MJ, Greenberg NL, Cardon L, Morehead AJ, Zuckerman J, Thomas JD (2000) Relationship of echocardiographic indices to pulmonary capillary wedge pressures in healthy volunteers. J Am Coll Cardiol 36:1664–1669PubMedCrossRefGoogle Scholar
  30. 30.
    Jacques DC, Pinsky MR, Severyn D, Gorcsan J 3rd (2004) Influence of alterations in loading on mitral annular velocity by tissue Doppler echocardiography and its associated ability to predict filling pressures. Chest 126:1910–1918PubMedCrossRefGoogle Scholar
  31. 31.
    Firstenberg MS, Greenberg NL, Main ML, Drinko JK, Odabashian JA, Thomas JD, Garcia MJ (2001) Determinants of diastolic myocardial tissue Doppler velocities: influences of relaxation and preload. J Appl Physiol 90:299–307PubMedGoogle Scholar
  32. 32.
    Braunwald E, Sonnenblick EH, Ross J (1988) Mechanisms of cardiac contraction and relaxation. In: Braunwald E (ed) Heart disease. Saunders, Philadelphia, pp 383–425Google Scholar
  33. 33.
    Wong DH, Tremper KK, Zaccari J, Hajduczek J, Konchigeri HN, Hufstedler SM (1988) Acute cardiovascular response to passive leg raising. Crit Care Med 16:123–125PubMedCrossRefGoogle Scholar
  34. 34.
    Poelaert JI (2001) Haemodynamic monitoring. Curr Opin Anaesthesiol 14:27–32PubMedCrossRefGoogle Scholar
  35. 35.
    Slama M, Masson H, Teboul JL, Arnout ML, Susic D, Frohlich E, Andrejak M (2002) Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol 283:H1729–H1733PubMedGoogle Scholar
  36. 36.
    De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL (2005) Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 31:517–523PubMedCrossRefGoogle Scholar
  37. 37.
    Cholley BP, Vieillard-Baron A, Mebazaa A (2006) Echocardiography in the ICU: time for widespread use! Intensive Care Med 32:9–10PubMedCrossRefGoogle Scholar
  38. 38.
    Vignon P (2005) Hemodynamic assessment of critically ill patients using echocardiography Doppler. Curr Opin Crit Care 11:227–234PubMedCrossRefGoogle Scholar
  39. 39.
    Vieillard-Baron A, Charron C, Chergui K, Peyrouset O, Jardin F (2006) Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient? Intensive Care Med 32:1547–1552PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bouchra Lamia
    • 1
  • Ana Ochagavia
    • 1
  • Xavier Monnet
    • 1
  • Denis Chemla
    • 1
    • 2
  • Christian Richard
    • 1
  • Jean-Louis Teboul
    • 1
  1. 1.Service de Réanimation MédicaleCentre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris SudLe Kremlin-BicêtreFrance
  2. 2.Service d’Explorations FonctionnellesCentre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, EA 4046, Université Paris SudLe Kremlin-BicêtreFrance

Personalised recommendations