Intensive Care Medicine

, Volume 41, Issue 3, pp 487–494 | Cite as

Passive leg raising performed before a spontaneous breathing trial predicts weaning-induced cardiac dysfunction

  • Martin DresEmail author
  • Jean-Louis Teboul
  • Nadia Anguel
  • Laurent Guerin
  • Christian Richard
  • Xavier Monnet



Weaning-induced cardiac dysfunction is more likely to occur if the heart does not tolerate the changes in loading conditions induced by spontaneous breathing trial (SBT). We hypothesized that the presence of cardiac preload independence before an SBT is associated with weaning failure related to cardiac dysfunction.


We included 30 patients after a first failed 1-h T-tube SBT who had a transpulmonary thermodilution already in place. Preload independence [no increase in the pulse contour analysis-derived cardiac index ≥10 % during passive leg raising (PLR)] was assessed before the second SBT. Failure of the SBT related to cardiac dysfunction was defined by an increase in pulmonary artery occlusion pressure above 18 mmHg at the end of the SBT associated with clinical intolerance.


Fifty-seven SBTs were analyzed. The SBT failed in 46 cases. Overall, 31 failed SBTs were associated with weaning-induced cardiac dysfunction. During PLR, the cardiac index did not change in cases of failed SBTs with cardiac dysfunction, whereas it significantly increased in the other cases: 4 % (interquartile range, IQR 0–5) vs. 12 % (IQR 11–15), respectively. If PLR did not increase the cardiac index by more than 10 % before the SBT, the occurrence of SBT failure related to cardiac dysfunction was predicted with a sensitivity of 97 % [95 % confidence interval (CI) 83–100], specificity of 81 % (95 % CI 61–93) and area under the receiver-operating characteristic curve of 0.88 (95 % CI 0.78–0.98).


Preload independence assessed by a negative PLR test performed before an SBT predicts weaning failure related to cardiac dysfunction.


Mechanical ventilation Weaning Pulmonary edema Passive leg raising 


Conflicts of interest

Jean-Louis Teboul and Xavier Monnet are members of the Medical Advisory Board of Pulsion Medical Systems. Martin Dres received honoraria for lectures from Pulsion Medical Systems. The other authors have no financial interest to disclose.

Supplementary material

134_2015_3653_MOESM1_ESM.pdf (28 kb)
Supplementary material 1 (PDF 28 kb)
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Supplementary material 2 (PDF 39 kb)
134_2015_3653_MOESM3_ESM.doc (49 kb)
Supplementary material 3 (DOC 49 kb)
134_2015_3653_MOESM4_ESM.doc (41 kb)
Supplementary material 4 (DOC 41 kb)


  1. 1.
    Teboul J-L (2014) Weaning-induced cardiac dysfunction: where are we today? Intensive Care Med 40:1069–1079CrossRefPubMedGoogle Scholar
  2. 2.
    Monnet X, Teboul JL (2008) Passive leg raising. Intensive Care Med 34:659–663CrossRefPubMedGoogle Scholar
  3. 3.
    Lamia B, Ochagavia A, Monnet X et al (2007) Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med 33:1125–1132CrossRefPubMedGoogle Scholar
  4. 4.
    Maizel J, Airapetian N, Lorne E et al (2007) Diagnosis of central hypovolemia by using passive leg raising. Intensive Care Med 33:1133–1138CrossRefPubMedGoogle Scholar
  5. 5.
    Monnet X, Bleibtreu A, Ferré A et al (2012) Passive leg-raising and end-expiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance. Crit Care Med 40:152–157CrossRefPubMedGoogle Scholar
  6. 6.
    Monnet X, Dres M, Ferré A et al (2012) Prediction of fluid responsiveness by a continuous non-invasive assessment of arterial pressure in critically ill patients: comparison with four other dynamic indices. Br J Anaesth 109:330–338CrossRefPubMedGoogle Scholar
  7. 7.
    Biais M, Nouette-Gaulain K, Roullet S et al (2009) A comparison of stroke volume variation measured by Vigileo/FloTrac system and aortic Doppler echocardiography. Anesth Analg 109:466–469CrossRefPubMedGoogle Scholar
  8. 8.
    Marik PE, Monnet X, Teboul JL (2011) Hemodynamic parameters to guide fluid therapy. Ann Intensive Care 1:1CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Dres M, Teboul J-L, Anguel N et al (2013) Preload independency as detected by passive leg raising is associated with weaning-induced pulmonary edema. In: Oral presentation at the ESCIM LIVES congress 2013Google Scholar
  10. 10.
    Boles J-M, Bion J, Connors A et al (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–1056CrossRefPubMedGoogle Scholar
  11. 11.
    Monnet X, Persichini R, Ktari M et al (2011) Precision of the transpulmonary thermodilution measurements. Crit Care 15:R204CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Jabot J, Teboul JL, Richard C, Monnet X (2009) Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med 35:85–90CrossRefPubMedGoogle Scholar
  13. 13.
    Lemaire F, Teboul JL, Cinotti L et al (1988) Acute left ventricular dysfunction during unsuccessful weaning from mechanical ventilation. Anesthesiology 69:171–179CrossRefPubMedGoogle Scholar
  14. 14.
    Monnet X, Rienzo M, Osman D et al (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407CrossRefPubMedGoogle Scholar
  15. 15.
    Moschietto S, Doyen D, Grech L et al (2012) Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome. Crit Care 16:R81CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Lamia B, Maizel J, Ochagavia A et al (2009) Echocardiographic diagnosis of pulmonary artery occlusion pressure elevation during weaning from mechanical ventilation. Crit Care Med 37:1696–1701CrossRefPubMedGoogle Scholar
  17. 17.
    Papanikolaou J, Makris D, Saranteas T et al (2011) New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 37:1976–1985CrossRefGoogle Scholar
  18. 18.
    Dres M, Teboul J-L, Anguel N et al (2014) Extravascular lung water, B-type natriuretic peptide, and blood volume contraction enable diagnosis of weaning-induced pulmonary edema. Crit Care Med 42:1882–1889CrossRefPubMedGoogle Scholar
  19. 19.
    Engineer RS, Benoit JL, Hicks CW et al (2012) Hemodynamic changes as a diagnostic tool in acute heart failure—a pilot study. Am J Emerg Med 30:174–180CrossRefPubMedGoogle Scholar
  20. 20.
    García X, Simon P, Guyette FX et al (2013) Noninvasive assessment of acute dyspnea in the ED. Chest 144:610–615CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Marik PE, Levitov A, Young A, Andrews L (2013) The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest 143:364–370CrossRefPubMedGoogle Scholar
  22. 22.
    Kupersztych-Hagege E, Teboul J-L, Artigas A et al (2013) Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth 111:961–966CrossRefPubMedGoogle Scholar
  23. 23.
    Perren A, Brochard L (2013) Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med 39:1885–1895CrossRefPubMedGoogle Scholar
  24. 24.
    Caille V, Amiel J-B, Charron C et al (2010) Echocardiography: a help in the weaning process. Crit Care 14:R120CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Zapata L, Vera P, Roglan A et al (2011) B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med 37:477–485CrossRefPubMedGoogle Scholar
  26. 26.
    Anguel N, Monnet X, Osman D et al (2008) Increase in plasma protein concentration for diagnosing weaning-induced pulmonary oedema. Intensive Care Med 34:1231–1238CrossRefPubMedGoogle Scholar
  27. 27.
    Grasso S, Leone A, De Michele M et al (2007) Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med 35:96–105CrossRefPubMedGoogle Scholar
  28. 28.
    Dres M, Teboul J-L, Monnet X (2014) Weaning the cardiac patient from mechanical ventilation. Curr Opin Crit Care 20:493–498CrossRefPubMedGoogle Scholar
  29. 29.
    Mekontso-Dessap A, de Prost N, Girou E et al (2006) B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 32:1529–1536CrossRefPubMedGoogle Scholar
  30. 30.
    Jubran A, Mathru M, Dries D, Tobin MJ (1998) Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med 158:1763–1769CrossRefPubMedGoogle Scholar
  31. 31.
    Thille AW, Richard J-CM, Brochard L (2013) The decision to extubate in the intensive care unit. Am J Respir Crit Care Med 187:1294–1302CrossRefPubMedGoogle Scholar
  32. 32.
    Mekontso Dessap A, Roche-Campo F, Kouatchet A et al (2012) Natriuretic peptide-driven fluid management during ventilator weaning: a randomized controlled trial. Am J Respir Crit Care Med 186:1256–1263CrossRefPubMedGoogle Scholar
  33. 33.
    Cabello B, Thille AW, Roche-Campo F et al (2010) Physiological comparison of three spontaneous breathing trials in difficult-to-wean patients. Intensive Care Med 36:1171–1179CrossRefPubMedGoogle Scholar
  34. 34.
    Demoule A, Lefort Y, Lopes M-E, Lemaire F (2004) Successful weaning from mechanical ventilation after coronary angioplasty. Br J Anaesth 93:295–297CrossRefPubMedGoogle Scholar
  35. 35.
    Adamopoulos C, Tsagourias M, Arvaniti K et al (2005) Weaning failure from mechanical ventilation due to hypertrophic obstructive cardiomyopathy. Intensive Care Med 31:734–737CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Martin Dres
    • 1
    • 2
    Email author
  • Jean-Louis Teboul
    • 1
    • 2
  • Nadia Anguel
    • 2
  • Laurent Guerin
    • 1
    • 2
  • Christian Richard
    • 1
    • 2
  • Xavier Monnet
    • 1
    • 2
  1. 1.EA4533Université Paris-SudLe Kremlin-BicêtreFrance
  2. 2.Service de réanimation médicaleHôpital de Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique, Hôpitaux de ParisLe Kremlin-BicêtreFrance

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