Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study

Jihad Mallat; Marc Olivier Fischer; Maxime Granier; Christophe Vinsonneau; Marie Jonard; Yazine Mahjoub; Fawzi Ali Baghdadi; Sébastien Préau; Fabien Poher; Olivier Rebet; Belaid Bouhemad; Malcolm Lemyze; Mehdi Marzouk; Emmanuel Besnier; Fadi Hamed; Nadeem Rahman; Osama Abou-Arab; Pierre Grégoire Guinot

doi:10.1016/j.bja.2022.04.031

Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study

Jihad Mallat
, Marc Olivier Fischer
, Maxime Granier
, Christophe Vinsonneau
, Marie Jonard
, Yazine Mahjoub
, Fawzi Ali Baghdadi
, Sébastien Préau
, Fabien Poher
, Olivier Rebet
, Belaid Bouhemad
, Malcolm Lemyze
, Mehdi Marzouk
, Emmanuel Besnier
, Fadi Hamed
, Nadeem Rahman
, Osama Abou-Arab
, Pierre Grégoire Guinot

Cleveland Clinic Abu Dhabi

Arras Hospital
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Normandy University
Hôpital de Béthune
Service de neurologie
Centre Hospitalier de Cambrai
Université de Lille
Centre Hospitalier de Boulogne Sur Mer
Schaffner Hospital
Université de Bourgogne
CHU Hôpitaux de Rouen
UniversiteD́ de Franche-Comté

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

Abstract

Background: Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPV_PLR) can also predict fluid responsiveness in mechanically ventilated patients. Methods: In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPV_PLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPV_PLR. Results: Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6–7.6) ml kg⁻¹ ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPV_PLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88–0.95; P<0.001) each. The grey zone for relative and absolute ΔPPV_PLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). Conclusions: Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. Clinical trial registration: NCT 03225378.

Original language	English
Pages (from-to)	308-316
Number of pages	9
Journal	British Journal of Anaesthesia
Volume	129
Issue number	3
DOIs	https://doi.org/10.1016/j.bja.2022.04.031
State	Published - Sep 2022

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

acute circulatory failure
cardiac output
fluid challenge
grey zone
pulse pressure variation
sepsis

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10.1016/j.bja.2022.04.031

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Mallat, J., Fischer, M. O., Granier, M., Vinsonneau, C., Jonard, M., Mahjoub, Y., Baghdadi, F. A., Préau, S., Poher, F., Rebet, O., Bouhemad, B., Lemyze, M., Marzouk, M., Besnier, E., Hamed, F., Rahman, N., Abou-Arab, O., & Guinot, P. G. (2022). Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study. British Journal of Anaesthesia, 129(3), 308-316. https://doi.org/10.1016/j.bja.2022.04.031

@article{eb994e6c274c4b6c997e33249e3f1afa,

title = "Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study",

abstract = "Background: Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients. Methods: In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15\% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR. Results: Of the 270 patients, 238 (88\%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12\%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6–7.6) ml kg−1 ideal body weight. One hundred sixty-four patients (61\%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95\% confidence interval [95\% CI], 0.88–0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8\% and 22.6\% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). Conclusions: Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. Clinical trial registration: NCT 03225378.",

keywords = "acute circulatory failure, cardiac output, fluid challenge, grey zone, pulse pressure variation, sepsis",

author = "Jihad Mallat and Fischer, \{Marc Olivier\} and Maxime Granier and Christophe Vinsonneau and Marie Jonard and Yazine Mahjoub and Baghdadi, \{Fawzi Ali\} and S{\'e}bastien Pr{\'e}au and Fabien Poher and Olivier Rebet and Belaid Bouhemad and Malcolm Lemyze and Mehdi Marzouk and Emmanuel Besnier and Fadi Hamed and Nadeem Rahman and Osama Abou-Arab and Guinot, \{Pierre Gr{\'e}goire\}",

note = "Publisher Copyright: {\textcopyright} 2022 British Journal of Anaesthesia",

year = "2022",

month = sep,

doi = "10.1016/j.bja.2022.04.031",

language = "English",

volume = "129",

pages = "308--316",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier Ltd.",

number = "3",

}

Mallat, J, Fischer, MO, Granier, M, Vinsonneau, C, Jonard, M, Mahjoub, Y, Baghdadi, FA, Préau, S, Poher, F, Rebet, O, Bouhemad, B, Lemyze, M, Marzouk, M, Besnier, E, Hamed, F , Rahman, N, Abou-Arab, O & Guinot, PG 2022, 'Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study', British Journal of Anaesthesia, vol. 129, no. 3, pp. 308-316. https://doi.org/10.1016/j.bja.2022.04.031

Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study. / Mallat, Jihad; Fischer, Marc Olivier; Granier, Maxime et al.
In: British Journal of Anaesthesia, Vol. 129, No. 3, 09.2022, p. 308-316.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients

T2 - a multicentre prospective observational study

AU - Mallat, Jihad

AU - Fischer, Marc Olivier

AU - Granier, Maxime

AU - Vinsonneau, Christophe

AU - Jonard, Marie

AU - Mahjoub, Yazine

AU - Baghdadi, Fawzi Ali

AU - Préau, Sébastien

AU - Poher, Fabien

AU - Rebet, Olivier

AU - Bouhemad, Belaid

AU - Lemyze, Malcolm

AU - Marzouk, Mehdi

AU - Besnier, Emmanuel

AU - Hamed, Fadi

AU - Rahman, Nadeem

AU - Abou-Arab, Osama

AU - Guinot, Pierre Grégoire

PY - 2022/9

Y1 - 2022/9

N2 - Background: Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients. Methods: In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR. Results: Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6–7.6) ml kg−1 ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88–0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). Conclusions: Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. Clinical trial registration: NCT 03225378.

AB - Background: Passive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients. Methods: In this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR. Results: Of the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6–7.6) ml kg−1 ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88–0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment). Conclusions: Passive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation. Clinical trial registration: NCT 03225378.

KW - acute circulatory failure

KW - cardiac output

KW - fluid challenge

KW - grey zone

KW - pulse pressure variation

KW - sepsis

UR - https://www.scopus.com/pages/publications/85134484711

U2 - 10.1016/j.bja.2022.04.031

DO - 10.1016/j.bja.2022.04.031

M3 - Article

C2 - 35842352

AN - SCOPUS:85134484711

SN - 0007-0912

VL - 129

SP - 308

EP - 316

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 3

ER -

Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study

Abstract

UN SDGs

Keywords

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