Differential Cardiac Responses after Passive Leg Raising

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dc.contributor.authorCastro, Ricardo
dc.contributor.authorKattan, Eduardo
dc.contributor.authorHernandez, Glenn
dc.contributor.authorBakker, Jan
dc.date.accessioned2025-01-20T16:16:15Z
dc.date.available2025-01-20T16:16:15Z
dc.date.issued2024
dc.description.abstractThis study retrospectively examined the hemodynamic effects of passive leg raising (PLR) in mechanically ventilated patients during fluid removal before spontaneous breathing trials. In previous studies, we noticed varying cardiac responses after PLR completion, particularly in positive tests. Using a bioreactance monitor, we recorded and analyzed hemodynamic parameters, including stroke volume and cardiac index (CI), before and after PLR in post-acute ICU patients. We included 27 patients who underwent 60 PLR procedures. In preload-unresponsive patients, no significant CI changes were observed (CI_t-6 = 3.7 [2.6; 4.7] mL/min/m2 vs. CI_t9 = 3.3 [2.5; 3.4] mL/min/m2; p = 0.306), while in preload-responsive patients, two distinct CI response types to PLR were identified: a transient peak with immediate return to baseline (CI_t-6 = 2.7 [2.5; 3.1] mL/min/m2 vs. 3.3 [2.6; 3.8] L/min/m2; p = 0.119) and a sustained CI elevation lasting beyond the PLR maneuver (CI_t-6 = 2.8 [2.3; 2.9] L/min/m2 vs. 3.3 [2.8; 3.9] ml/min/m2; p = 0.034). The latter was particularly noted when Delta CI during PLR exceeded 25%. Our findings suggest that in certain preload-responsive patients, PLR can induce a more sustained increase in CI, indicating a possible persistent hemodynamic effect. This effect could be due to a combination of autotransfusion and sympathetic activation affecting venous return and vascular tone. Further research in larger cohorts and more comprehensive hemodynamic assessments are warranted to validate these observations and elucidate the possible underlying mechanisms.The Fluid unLoading On Weaning (FLOW) study was prospectively registered under the ID NCT04496583 on 2020-07-29 at ClinicalTrials.gov.
dc.description.funderAgencia Nacional de Investigacin y Desarrollo
dc.fuente.origenWOS
dc.identifier.doi10.1007/s10877-024-01180-z
dc.identifier.eissn1573-2614
dc.identifier.issn1387-1307
dc.identifier.urihttps://doi.org/10.1007/s10877-024-01180-z
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/90538
dc.identifier.wosidWOS:001243273500002
dc.issue.numero5
dc.language.isoen
dc.pagina.final996
dc.pagina.inicio991
dc.revistaJournal of clinical monitoring and computing
dc.rightsacceso restringido
dc.subjectPreload-responsiveness
dc.subjectFluid-responsiveness
dc.subjectCardiac index
dc.subjectPassive leg raise
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDifferential Cardiac Responses after Passive Leg Raising
dc.typeartículo
dc.volumen38
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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