Supine transfer test-induced changes in cardiac index predict fluid responsiveness in patients without intra-abdominal hypertension.
Cardiac index
Fluid responsiveness
Intra-abdominal hypertension
Supine transfer
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
18 09 2023
18 09 2023
Historique:
received:
06
07
2023
accepted:
14
09
2023
medline:
20
9
2023
pubmed:
19
9
2023
entrez:
18
9
2023
Statut:
epublish
Résumé
The reversible maneuver that mimics the fluid challenge is a widely used test for evaluating volume responsiveness. However, passive leg raising (PLR) does have certain limitations. The aim of the study is to determine whether the supine transfer test could predict fluid responsiveness in adult patients with acute circulatory failure who do not have intra-abdominal hypertension, by measuring changes in cardiac index (CI). Single-center, prospective clinical study in a 25-bed surgery intensive care unit at the Fudan University Shanghai Cancer Center. Thirty-four patients who presented with acute circulatory failure and were scheduled for fluid therapy. Every patient underwent supine transfer test and fluid challenge with 500 mL saline for 15-30 min. There were four sequential steps in the protocol: (1) baseline-1: a semi-recumbent position with the head of the bed raised to 45°; (2) supine transfer test: patients were transferred from the 45° semi-recumbent position to the strict supine position; (3) baseline-2: return to baseline-1 position; and (4) fluid challenge: administration of 500 mL saline for 15-30 min. Hemodynamic parameters were recorded at each step with arterial pulse contour analysis (ProAQT/Pulsioflex). A fluid responder was defined as an increase in CI ≥ 15% after fluid challenge. The receiver operating characteristic curve and gray zone were defined for CI. Seventeen patients were fluid challenge. The r value of the linear correlations was 0.73 between the supine transfer test- and fluid challenge-induced relative CI changes. The relative changes in CI induced by supine transfer in predicting fluid responsiveness had an area under the receiver operating characteristic curve of 0.88 (95% confidence interval 0.72-0.97) and predicted a fluid responder with 76.5% (95% confidence interval 50.1-93.2) sensitivity and 88.2% (95% confidence interval 63.6-98.5) specificity, at a best threshold of 5.5%. Nineteen (55%) patients were in the gray zone (CI ranging from -3 and 8 L/min/m The supine transfer test can potentially assist in detecting fluid responsiveness in patients with acute circulatory failure without intra-abdominal hypertension. Nevertheless, the small threshold and the 55% gray zone were noteworthy limitation. Predicting fluid responsiveness with supine transition test (ChiCTR2200058264). Registered 2022-04-04 and last refreshed on 2023-03-26, https://www.chictr.org.cn/showproj.html?proj=166175 .
Sections du résumé
BACKGROUND
The reversible maneuver that mimics the fluid challenge is a widely used test for evaluating volume responsiveness. However, passive leg raising (PLR) does have certain limitations. The aim of the study is to determine whether the supine transfer test could predict fluid responsiveness in adult patients with acute circulatory failure who do not have intra-abdominal hypertension, by measuring changes in cardiac index (CI).
METHODS
Single-center, prospective clinical study in a 25-bed surgery intensive care unit at the Fudan University Shanghai Cancer Center. Thirty-four patients who presented with acute circulatory failure and were scheduled for fluid therapy. Every patient underwent supine transfer test and fluid challenge with 500 mL saline for 15-30 min. There were four sequential steps in the protocol: (1) baseline-1: a semi-recumbent position with the head of the bed raised to 45°; (2) supine transfer test: patients were transferred from the 45° semi-recumbent position to the strict supine position; (3) baseline-2: return to baseline-1 position; and (4) fluid challenge: administration of 500 mL saline for 15-30 min. Hemodynamic parameters were recorded at each step with arterial pulse contour analysis (ProAQT/Pulsioflex). A fluid responder was defined as an increase in CI ≥ 15% after fluid challenge. The receiver operating characteristic curve and gray zone were defined for CI.
RESULTS
Seventeen patients were fluid challenge. The r value of the linear correlations was 0.73 between the supine transfer test- and fluid challenge-induced relative CI changes. The relative changes in CI induced by supine transfer in predicting fluid responsiveness had an area under the receiver operating characteristic curve of 0.88 (95% confidence interval 0.72-0.97) and predicted a fluid responder with 76.5% (95% confidence interval 50.1-93.2) sensitivity and 88.2% (95% confidence interval 63.6-98.5) specificity, at a best threshold of 5.5%. Nineteen (55%) patients were in the gray zone (CI ranging from -3 and 8 L/min/m
CONCLUSION
The supine transfer test can potentially assist in detecting fluid responsiveness in patients with acute circulatory failure without intra-abdominal hypertension. Nevertheless, the small threshold and the 55% gray zone were noteworthy limitation.
TRIAL REGISTRATION
Predicting fluid responsiveness with supine transition test (ChiCTR2200058264). Registered 2022-04-04 and last refreshed on 2023-03-26, https://www.chictr.org.cn/showproj.html?proj=166175 .
Identifiants
pubmed: 37723480
doi: 10.1186/s12871-023-02280-0
pii: 10.1186/s12871-023-02280-0
pmc: PMC10506238
doi:
Substances chimiques
Saline Solution
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
318Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Aya HD, Ster IC, Fletcher N, et al. Pharmacodynamic analysis of a fluid challenge. Crit Care Med. 2016;44:880–91.
doi: 10.1097/CCM.0000000000001517
pubmed: 26683506
Messina A, Longhini F, Coppo C, et al. Use of the fluid challenge in critically ill adult patients: a systematic review. Anesth Analg. 2017;125:1532–43.
doi: 10.1213/ANE.0000000000002103
pubmed: 28514324
De Backer D, Aissaoui N, Cecconi M, et al. How can assessing hemodynamics help to assess volume status? Intensive Care Med. 2022;48(10):1482–94.
doi: 10.1007/s00134-022-06808-9
pubmed: 35945344
pmcid: 9363272
Monnet X, Malbrain MLNG, Pinsky MR. The prediction of fluid responsiveness. Intensive Care Med. 2023;49(1):83–6.
doi: 10.1007/s00134-022-06900-0
pubmed: 36323911
Teboul JL, Monnet X, Chemla D, et al. Arterial pulse pressure variation with mechanical ventilation. Am J Respir Crit Care Med. 2019;199(1):22–31.
doi: 10.1164/rccm.201801-0088CI
pubmed: 30138573
Alvarado Sánchez JI, Caicedo Ruiz JD, Diaztagle Fernández JJ, et al. Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis. Ann Intensive Care. 2021;11(1):28.
doi: 10.1186/s13613-021-00817-5
pubmed: 33555488
pmcid: 7870741
Jabot J, Teboul JL, Richard C, et al. Passive leg raising for predicting fluid responsiveness: Importance of the postural change. Intensive Care Med. 2009;35:85–90.
doi: 10.1007/s00134-008-1293-3
pubmed: 18795254
He HW, Liu DW. Passive leg raising in intensive care medicine. Chin Med J (Engl). 2016;129:1755–8.
doi: 10.4103/0366-6999.185866
pubmed: 27411467
Lai C, Adda I, Teboul JL, et al. Effects of prone positioning on venous return in patients with acute respiratory distress syndrome. Crit Care Med. 2021;49:781–9.
doi: 10.1097/CCM.0000000000004849
pubmed: 33590997
Monnet X, Anguel N, Naudin B, et al. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices. Crit Care. 2010;14(3):R109.
doi: 10.1186/cc9058
pubmed: 20537159
pmcid: 2911755
de Courson H, Ferrer L, Cane G, et al. Evaluation of least significant changes of pulse contour analysis-derived parameters. Ann Intensive Care. 2019;9:116.
doi: 10.1186/s13613-019-0590-z
pubmed: 31602550
pmcid: 6787117
Vistisen ST, Scheeren TWL. Challenge of the mini-fluid challenge: filling twice without creating a self-fulfilling prophecy design. Anesthesiology. 2018;128:1043–4.
doi: 10.1097/ALN.0000000000002141
pubmed: 29664782
Messina A, Dell’Anna A, Baggiani M, et al. Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness. Crit Care. 2019;23(1):264.
doi: 10.1186/s13054-019-2545-z
pubmed: 31358025
pmcid: 6664788
Malbrain MLNG, De Keulenaer BL, Khanna AK. Continuous intra-abdominal pressure: is it ready for prime time? Intensive Care Med. 2022;48(10):1501–4.
doi: 10.1007/s00134-022-06780-4
pubmed: 35925322
pmcid: 9468118
Taylor CJ, Ordóñez-Mena JM, Roalfe AK, et al. Trends in survival after a diagnosis of heart failure in the United Kingdom 2000–2017: population based cohort study. BMJ. 2019;364:l223.
doi: 10.1136/bmj.l223
pubmed: 30760447
pmcid: 6372921
Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19:18.
doi: 10.1186/s13054-014-0708-5
pubmed: 25658678
pmcid: 4293822
Yonis H, Bitker L, Aublanc M, et al. Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation. Crit Care. 2017;21:295.
doi: 10.1186/s13054-017-1881-0
pubmed: 29208025
pmcid: 5718075
Shah P, Louis MA. Physiology, Central Venous Pressure. 2023. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
Saugel B, Kouz K, Meidert AS, et al. How to measure blood pressure using an arterial catheter: a systematic 5-step approach. Crit Care. 2020;24(1):172.
doi: 10.1186/s13054-020-02859-w
pubmed: 32331527
pmcid: 7183114
Robin X, Turck N, Hainard A, et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics. 2011;12:77.
doi: 10.1186/1471-2105-12-77
pubmed: 21414208
pmcid: 3068975
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837–45.
doi: 10.2307/2531595
pubmed: 3203132
Le Manach Y, Hofer CK, Lehot JJ, et al. Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period? Anesthesiology. 2012;117(6):1165–74.
doi: 10.1097/ALN.0b013e318275561d
pubmed: 23135262
Ray P, Le Manach Y, Riou B, et al. Statistical evaluation of a biomarker. Anesthesiology. 2010;112:1023–40.
doi: 10.1097/ALN.0b013e3181d47604
pubmed: 20234303
Cannesson M, Le Manach Y, Hofer CK, et al. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology. 2011;115:231–41.
doi: 10.1097/ALN.0b013e318225b80a
pubmed: 21705869
Biais M, Ehrmann S, Mari A, et al. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care. 2014;18:587.
doi: 10.1186/s13054-014-0587-9
pubmed: 25658489
pmcid: 4240833
Zhao Z, Zhang Z, Lin Q, et al. 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;9:862226.
doi: 10.3389/fmed.2022.862226
pubmed: 35479952
Mohammad NS, Nazli R, Zafar H, et al. Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: a randomized clinical trial. Pak J Med Sci. 2022;38:219–26.
pubmed: 35035429
pmcid: 8713215
Beurton A, Teboul JL, Gavelli F, et al. The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients. Crit Care. 2019;23(1):19.
doi: 10.1186/s13054-019-2306-z
pubmed: 30658663
pmcid: 6339274
Hamzaoui O, Shi R, Carelli S, et al. Changes in pulse pressure variation to assess preload responsiveness in mechanically ventilated patients with spontaneous breathing activity: an observational study. Br J Anaesth. 2021;127(4):532–8.
doi: 10.1016/j.bja.2021.05.034
pubmed: 34246460
Taccheri T, Gavelli F, Teboul JL, et al. Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation? Crit Care. 2021;25(1):110.
doi: 10.1186/s13054-021-03515-7
pubmed: 33736672
pmcid: 7972024
Mahjoub Y, Touzeau J, Airapetian N, et al. The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med. 2010;38:1824–9.
doi: 10.1097/CCM.0b013e3181eb3c21
pubmed: 20639753
Beurton A, Teboul JL, Girotto V, et al. Intra-abdominal hypertension is responsible for false negatives to the passive leg raising test. Crit Care Med. 2019;47:e639–47.
doi: 10.1097/CCM.0000000000003808
pubmed: 31306258
Jozwiak M, Mercado P, Teboul JL, et al. What is the lowest change in cardiac output that transthoracic echocardiography can detect? Crit Care. 2019;23(1):116.
doi: 10.1186/s13054-019-2413-x
pubmed: 30971307
pmcid: 6458708