Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Research

The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients

Authors: Alexandra Beurton, Jean-Louis Teboul, Francesco Gavelli, Filipe Andre Gonzalez, Valentina Girotto, Laura Galarza, Nadia Anguel, Christian Richard, Xavier Monnet

Published in: Critical Care | Issue 1/2019

Login to get access

Abstract

Background

A passive leg raising (PLR) test is positive if the cardiac index (CI) increased by > 10%, but it requires a direct measurement of CI. On the oxygen saturation plethysmographic signal, the perfusion index (PI) is the ratio between the pulsatile and the non-pulsatile portions. We hypothesised that the changes in PI could predict a positive PLR test and thus preload responsiveness in a totally non-invasive way.

Methods

In patients with acute circulatory failure, we measured PI (Radical-7) and CI (PiCCO2) before and during a PLR test and, if decided, before and after volume expansion (500-mL saline).

Results

Three patients were excluded because the plethysmography signal was absent and 3 other ones because it was unstable. Eventually, 72 patients were analysed. In 34 patients with a positive PLR test (increase in CI ≥ 10%), CI and PI increased during PLR by 21 ± 10% and 54 ± 53%, respectively. In the 38 patients with a negative PLR test, PI did not significantly change during PLR. In 26 patients in whom volume expansion was performed, CI and PI increased by 28 ± 14% and 53 ± 63%, respectively. The correlation between the PI and CI changes for all interventions was significant (r = 0.64, p < 0.001). During the PLR test, if PI increased by > 9%, a positive response of CI (≥ 10%) was diagnosed with a sensitivity of 91 (76–98%) and a specificity of 79 (63–90%) (area under the receiver operating characteristics curve 0.89 (0.80–0.95), p < 0.0001).

Conclusion

An increase in PI during PLR by 9% accurately detects a positive response of the PLR test.

Trial registration

ID RCB 2016-A00959-42. Registered 27 June 2016.
Appendix
Available only for authorised users
Literature
1.
Monnet X, Marik PE, Teboul J-L. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
2.
Vincent J-L, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 2006;34(2):344–53.
3.
Acheampong A, Vincent J-L. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care Lond Engl. 2015;19:251.
4.
National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354(24):2564–75.
5.
Jozwiak M, Silva S, Persichini R, Anguel N, Osman D, Richard C, et al. Extravascular lung water is an independent prognostic factor in patients with acute respiratory distress syndrome. Crit Care Med. 2013;41(2):472–80.
6.
Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid! Crit Care Lond Engl. 2015;19:18.
7.
Guérin L, Teboul J-L, Persichini R, Dres M, Richard C, Monnet X. Effects of passive leg raising and volume expansion on mean systemic pressure and venous return in shock in humans. Crit Care Lond Engl. 2015;19:411.
8.
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34(5):1402–7.
9.
Monnet X, Marik P, Teboul J-L. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016;42(12):1935–47.
10.
Cherpanath TGV, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, et al. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials. Crit Care Med. 2016;44(5):981–91.
11.
Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30(6):1210–3.
12.
Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse oximetry. J Clin Monit Comput. 2000;16(7):475–83.
13.
Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Med. 2005 Oct;31(10):1316–26.
14.
van Genderen ME, Bartels SA, Lima A, Bezemer R, Ince C, Bakker J, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013;116(2):351–6.
15.
Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. Br J Anaesth. 2013;111(2):235–41.
16.
Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39(7):1190–206.
17.
Jozwiak M, Monnet X, Teboul J-L. Pressure Waveform Analysis. Anesth Analg. 2017.
18.
Monnet X, Teboul J-L. Transpulmonary thermodilution: advantages and limits. Crit Care Lond Engl. 2017;21(1):147.
19.
Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul J-L. Precision of the transpulmonary thermodilution measurements. Crit Care. 2011;15(4):R204.
20.
Monnet X, Cipriani F, Camous L, Sentenac P, Dres M, Krastinova E, et al. The passive leg raising test to guide fluid removal in critically ill patients. Ann Intensive Care. 2016;6(1):46.
21.
Cecconi M, Rhodes A. Validation of continuous cardiac output technologies: consensus still awaited. Crit Care Lond Engl. 2009;13(3):159.
22.
Hapfelmeier A, Cecconi M, Saugel B. Cardiac output method comparison studies: the relation of the precision of agreement and the precision of method. J Clin Monit Comput. 2016;30(2):149–55.
23.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.
24.
Mesquida J, Gruartmoner G, Ferrer R. Passive leg raising for assessment of volume responsiveness: a review. Curr Opin Crit Care. 2017;23(3):237–43.
25.
Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40(12):1795–815.
26.
Monnet X, Letierce A, Hamzaoui O, Chemla D, Anguel N, Osman D, et al. Arterial pressure allows monitoring the changes in cardiac output induced by volume expansion but not by norepinephrine. Crit Care Med. 2011;39(6):1394–9.
27.
Pierrakos C, Velissaris D, Scolletta S, Heenen S, De Backer D, Vincent J-L. Can changes in arterial pressure be used to detect changes in cardiac index during fluid challenge in patients with septic shock? Intensive Care Med. 2012;38(3):422–8.
28.
Broch O, Bein B, Gruenewald M, Höcker J, Schöttler J, Meybohm P, et al. Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index. Acta Anaesthesiol Scand. 2011;55(6):686–93.
29.
McGrath SP, Ryan KL, Wendelken SM, Rickards CA, Convertino VA. Pulse oximeter plethysmographic waveform changes in awake, spontaneously breathing, hypovolemic volunteers. Anesth Analg. 2011;112(2):368–74.
30.
Cannesson M, Delannoy B, Morand A, Rosamel P, Attof Y, Bastien O, et al. Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg. 2008;106(4):1189–94.
31.
Desgranges F-P, Desebbe O, Ghazouani A, Gilbert K, Keller G, Chiari P, et al. Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. Br J Anaesth. 2011;107(3):329–35.
32.
Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, et al. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth. 2008;101(2):200–6.
Metadata
Title
The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients
Authors
Alexandra Beurton
Jean-Louis Teboul
Francesco Gavelli
Filipe Andre Gonzalez
Valentina Girotto
Laura Galarza
Nadia Anguel
Christian Richard
Xavier Monnet
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2306-z

Other articles of this Issue 1/2019

Critical Care 1/2019 Go to the issue

Letter

Combined assessment of ΔPCT and ΔCRP could increase the ability to differentiate candidemia from bacteremia

Editorial

Is this patient really “(un)stable”? How to describe cardiovascular dynamics in critically ill patients

Research

Heterogeneity of treatment effect by baseline risk of mortality in critically ill patients: re-analysis of three recent sepsis and ARDS randomised controlled trials

Letter

Procalcitonin is an essential biomarker for hydrocortisone, ascorbic acid, and thiamine (HAT) therapy in patients with sepsis

Research

Trends in sepsis mortality over time in randomised sepsis trials: a systematic literature review and meta-analysis of mortality in the control arm, 2002–2016

Research

The association between autoimmune disease and 30-day mortality among sepsis ICU patients: a cohort study