Passive leg rising and pulse contour monitoring

Introduction

Passive leg rising is proved to be a predictive tool of fluid challenge in the ventilated patient. Pulse contour analysis remains an innovative technique, so there are many dark sides to explore in usual clinical practice.

Objective

To evaluate the PiCCO parameter responses to the passive leg rising position in ICU patients.

Patients and methods

All patients with PICCO monitoring under mechanical ventilation and deeply sedated were enrolled. When physicians needed fluid challenge, we noted parameters delivered beat to beat (Philipps Monitor), heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), continuous cardiac index (CCI) and stroke volume variation (SVV), in the supine position (SP), then at 1 and 5 min in the Tredelembourg position (TP) (bed at 45°, patient position unchanged on bed), then in the supine position and after 200 ml gelatine fluid challenge.

Results

We analysed nine measures in three ICU patients with septic shock: two received norepinephrine and one epinephrine as amine support. All patients were mechanically ventilated and deeply sedated. The TP leads to a decrease in HR, an increase in arterial pressure, a decrease in SVV, without any effect on the pulse contour cardiac index. Fluid loading increases arterial pressure but decreases the HR and SVV (Table 1).

Table 1

Conclusion

The TP mimics the effect of fluid loading. PiCCO parameters, especially SVV, can detect changes induced by the TP.