The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery
Abstract Background There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor...
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doaj-b8a1817972a548a7b616b17790d384512021-05-23T11:17:01ZengBMCBMC Pediatrics1471-24312021-05-012111710.1186/s12887-021-02703-2The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgeryDeqiang Luo0Wei Dai1Lei Lei2Xueying Cai3Department of Intensive Care Unit, The First Affiliated Hospital of Nanchang UniversityDepartment of Intensive Care Unit, The Fifth People’s Hospital of Shangrao CityDepartment of Animal Science, Hubei Vocational College Of Bio-TechnologyDepartment of Intensive Care Unit, The First Affiliated Hospital of Nanchang UniversityAbstract Background There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor of FR in children with mechanical ventilation after congenital cardiac surgery. Methods A total of 40 children with mechanical ventilation following congenital cardiac surgery, who required volume expansion (VE) were included in this study. Hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP), SV, and central venous pressure (CVP) were monitored before and after PLR and VE. Besides, we assessed changes in SV and CO by bedside ultrasound. Patients showing > 10 % increase in SV in response to VE were considered to be responders (26 patients), while the rest (14 patients) were defined as non-responders. Results Our data demonstrated that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, p < 0.001 and r = 0.374, p = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95 % CI [0.745 1.000], p < 0.001). The best cut-off value for ΔSV-PLR in predicting FR was 13 %, with its sensitivity and specificity were 81.8 and 86.3 %, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictors of FR in the children. Conclusions Our study demonstrated that SV changes, as evaluated by noninvasive ultrasound combined with PLR, could effectively evaluate FR in children under mechanical ventilation after congenital cardiac surgery.https://doi.org/10.1186/s12887-021-02703-2congenital heart surgeryfluid responsivenesspassive leg raisingultrasound |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Deqiang Luo Wei Dai Lei Lei Xueying Cai |
spellingShingle |
Deqiang Luo Wei Dai Lei Lei Xueying Cai The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery BMC Pediatrics congenital heart surgery fluid responsiveness passive leg raising ultrasound |
author_facet |
Deqiang Luo Wei Dai Lei Lei Xueying Cai |
author_sort |
Deqiang Luo |
title |
The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
title_short |
The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
title_full |
The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
title_fullStr |
The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
title_full_unstemmed |
The clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
title_sort |
clinical value of passive leg raising plus ultrasound to predict fluid responsiveness in children after cardiac surgery |
publisher |
BMC |
series |
BMC Pediatrics |
issn |
1471-2431 |
publishDate |
2021-05-01 |
description |
Abstract Background There are few non-invasive monitoring methods that can reliably predict fluid responsiveness (FR) in children. Here, we interrogate the value of doppler ultrasound evaluation of passive leg raising (PLR)-induced changes in stroke volume (SV) and cardiac output (CO) as a predictor of FR in children with mechanical ventilation after congenital cardiac surgery. Methods A total of 40 children with mechanical ventilation following congenital cardiac surgery, who required volume expansion (VE) were included in this study. Hemodynamic parameters such as heart rate (HR), mean arterial pressure (MAP), SV, and central venous pressure (CVP) were monitored before and after PLR and VE. Besides, we assessed changes in SV and CO by bedside ultrasound. Patients showing > 10 % increase in SV in response to VE were considered to be responders (26 patients), while the rest (14 patients) were defined as non-responders. Results Our data demonstrated that ΔSV-PLR and ΔCO- PLR were positively correlated with ΔSV-VE (r = 0.683, p < 0.001 and r = 0.374, p = 0.017, respectively), and the area under the ROC curve (AUC) of ΔSV-PLR was 0.879 (95 % CI [0.745 1.000], p < 0.001). The best cut-off value for ΔSV-PLR in predicting FR was 13 %, with its sensitivity and specificity were 81.8 and 86.3 %, respectively. ΔCVP, ΔHR, and ΔMAP were weak predictors of FR in the children. Conclusions Our study demonstrated that SV changes, as evaluated by noninvasive ultrasound combined with PLR, could effectively evaluate FR in children under mechanical ventilation after congenital cardiac surgery. |
topic |
congenital heart surgery fluid responsiveness passive leg raising ultrasound |
url |
https://doi.org/10.1186/s12887-021-02703-2 |
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