Evaluation of passive leg raising test for predicting fluid responsiveness in shock patients
Authors
OO Akanbi, DA Onilede, OA Olakulehin, OG Habeeb, OO Olanipekun, TA Akinloye, YA YunusaFiles
Key Information
Journal
Published in Vol. 6 No. 1 (2023) of Western Nigeria Journal of Medical Sciences.
WNJMS is published by UNIOSUN Teaching Hospital, Osun State, Nigeria (the training institution of Osun State University, Osogbo, Nigeria). The journal is a peer-reviewed, open-access publication of scholarly research in all fields of medical and health profession.
About the JournalAbstract
Introduction: Intravenous fluid administration remains the primary therapeutic intervention for haemodynamically unstable patients. However, studies have shown that about 50% of such patients would not respond to fluid therapy only. This study evaluates the predictive value of passive leg raising (PLR) test in predicting fluid responsiveness in shock patients.
Methods: Adult patients who were in a state of continuous shock (systolic blood pressure < 90mmHg) after initial fluid resuscitation in accident and emergency unit in a teaching hospital in Nigeria over a six-month period were enrolled. All the patients underwent passive leg raising (PLR) test, and were then divided into PLR responders (systolic blood pressure >90mmHg) and PLR non-responders (systolic blood pressure <90mmHg) following PLR. This was followed by further re-categorization into two sub-groups; those who responded to fluid therapy to maintain blood pressure (FTG) and those who required cardiotonic drugs (CTG). The pre-intervention and post-intervention vital signs were then retrospectively analysed between the groups.
Results: Twenty-five patients’ results were analysed for the study. The mean age of the patients was 50.6±4.64 years with male to female ratio of 1.2:1. The mean age of the patients in FTG and CTG were comparable (51.67±3.54 vs49.53±5.28; p= 0.2378). Twelve patients responded to Passive Leg Raising (PLR) test and 13 patients failed to respond to PLR. Nine (75%) out of 12 patients that responded to PLR were successfully managed with fluid therapy as compared to 2 (15.38%) out of 13 non-responders who were successfully managed with fluid therapy only (p=0.0094) giving PLR 75% and 85% positive predictive value and negative predictive value respectively in predicting pre-load dependent circulation.
Conclusion: Passive leg rising can be used as a guide for fluid replacement in patients with shock. Other interventions should be considered early in patients who failed to respond to passive leg raising.
