Comparison Between Changes in Systolic-Pressure Variation and Pulse-Pressure Variation After Passive Leg Raising to Predict Fluid Responsiveness in Postoperative Critically Ill Patients

Abstract

ObjectiveThe authors aimed to evaluate the precision of changes in systolic pressure variation after passive leg raising (PLR) as a predictor of fluid responsiveness in postoperative critically ill patients and to compare the precision of changes in pulse pressure variation after PLR (ΔPPVPLR) with changes in systolic pressure variation after PLR (ΔSPVPLR). DesignA prospective observational study. SettingA surgical intensive care unit of a tertiary hospital. Participants74 postoperative critically ill patients with acute circulatory failure were enrolled. InterventionsFluid responsiveness was defined as an increase of 10% or more in stroke volume after PLR, dividing patients into two groups: responders and nonresponders. Measurement and Main ResultsHemodynamic data were recorded at baseline and after PLR, and the stroke volume was measured by transthoracic echocardiography. 38 patients were responders, and 36 were nonresponders. ΔPPVPLR predicted fluid responsiveness with the areas under the receiver operating characteristic curves (AUC) of 0.917, and the optimal cut-off values were 2.3% with the grey zone of 1.6% to 3.3% including 19 (25.7%) patients. ΔSPVPLR predicted fluid responsiveness with the AUC of 0.908, and the optimal cut-off values were 1.9% with the grey zone of 1.1% to 2.0% including 18 (24.3%) patients. No notable distinction was observed between the AUC for ΔPPVPLR and ΔSPVPLR (p = 0.805) in predicting fluid responsiveness. ConclusionsΔSPVPLR and ΔPPVPLR could accurately predict fluid responsiveness in postoperative critically ill patients. There was no difference in the ability to predict fluid responsiveness between ΔSPVPLR and ΔPPVPLR.