Journal of clinical monitoring and computing · 2025
Evaluation of the mitral velocity-time integral changes induced by a passive leg raising test as a marker of fluid responsiveness in critically ill patients.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Aissaoui Younes, Jozwiak Mathieu, Bouchama Ayoub, Bennjakhoukh Hamza, Bencharfa Bassam, Didi Mehdi, Abouqal Redouane, Belhadj Ayoub
Аннотация
BACKGROUND: Assessing fluid responsiveness is crucial in managing critically ill patients. Echocardiography, particularly passive leg raising (PLR)-induced changes in the velocity-time integral of the left ventricular outflow tract (VTILVOT), is widely used for this purpose. We hypothesized that PLR-induced changes in the mitral valve velocity-time integral (VTIMi) could serve as a reliable alternative.
METHODS: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTILVOT and VTIMi were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTILVOT ≥10%. The ability of PLR-induced VTIMi changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses.
RESULTS: Fifty consecutive patients were included (median age 65 years [IQR: 57-73], APACHE II score 22 [IQR: 18-27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTIMi and VTILVOT were significantly correlated (ρ = 0.656, p < 0.001). The area under the ROC curve for VTIMi was 0.927 (95% CI: 0.849-1, p < 0.001). A 10% increase in VTIMi predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61-95) and specificity of 96% (95% CI: 83-99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort.
CONCLUSION: PLR-induced changes in VTIMi reliably predict fluid responsiveness in critically ill patients. VTIMi represents a viable alternative to VTILVOT for fluid responsiveness assessment, contributing to individualized hemodynamic management.
TRIAL REGISTRATION: NCT05538637.
METHODS: This prospective single-center study included septic ICU patients requiring fluid responsiveness assessment. VTILVOT and VTIMi were measured at baseline and after PLR. Fluid responsiveness was defined as a PLR-induced increase in VTILVOT ≥10%. The ability of PLR-induced VTIMi changes to predict fluid responsiveness was assessed via ROC curve and gray zone analyses.
RESULTS: Fifty consecutive patients were included (median age 65 years [IQR: 57-73], APACHE II score 22 [IQR: 18-27]). Septic shock was present in 27 (54%), 21 (42%) were mechanically ventilated, and 23 (46%) were classified as responders. PLR-induced changes in VTIMi and VTILVOT were significantly correlated (ρ = 0.656, p < 0.001). The area under the ROC curve for VTIMi was 0.927 (95% CI: 0.849-1, p < 0.001). A 10% increase in VTIMi predicted fluid responsiveness with a sensitivity of 83% (95% CI: 61-95) and specificity of 96% (95% CI: 83-99). The gray zone ranged between 5% and 8%, encompassing 16% of the cohort.
CONCLUSION: PLR-induced changes in VTIMi reliably predict fluid responsiveness in critically ill patients. VTIMi represents a viable alternative to VTILVOT for fluid responsiveness assessment, contributing to individualized hemodynamic management.
TRIAL REGISTRATION: NCT05538637.