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Brachial cuff measurements for fluid responsiveness prediction in the critically ill

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Critical Care201115 (Suppl 1) :P73

  • Published:


  • Arterial Pressure
  • Central Venous Pressure
  • Fluid Responsiveness
  • Positive Likelihood Ratio
  • Cardiac Preload


The passive leg raising maneuver (PLR) with concomitant measurement of invasive arterial pressure (AP) or cardiac output (CO) changes are used to test volume responsiveness. The initial hemodynamic evaluation of shocked patients often relies on the sole non-invasive measurement of AP. We assessed the performance of PLR-induced changes in oscillometric measurements of systolic, mean and pulse AP (ΔplrSAP, ΔplrMAP and ΔplrPP).


CO and AP measurements were performed before/during PLR and then after 500 ml volume expansion.


In 112 patients, the area under the ROC curve (AUC) of ΔplrSAP was 0.75 (0.66 to 0.83). When ΔplrSAP was >17%, the positive likelihood ratio (LHR) was 26 (18 to 38). Non-invasive ΔplrPP and non-invasive ΔplrMAP were associated with an AUC of 0.70 (0.61 to 0.79) and 0.69 (0.59 to 0.77), respectively. If PLR induced change in central venous pressure (CVP) it was ≥2 mmHg (n = 60), suggesting that PLR actually changed the cardiac preload, AUC of ΔplrSAP was 0.90 (0.80 to 0.97). In these patients, ΔplrSAP >9% was associated with a positive and negative LHR of 5.7 (4.6 to 6.8) and 0.07 (0.009 to 0.5), respectively. See Figure 1.
Figure 1
Figure 1

(abstract P73)


Regardless of CVP (blind PLR), ΔplrSAP >17% reliably identified responders. CVP-guided PLR allowed ΔplrSAP to perform better in the case of sufficient change in preload during PLR.

Authors’ Affiliations

CHU, Montpellier, France
CHRU, Tours, France
CHR, Orléans, France
Hopital Bichat-C.Bernard, Paris, France


© Lakhal et al. 2011

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.