目的: Background Prompt and accurate prediction of fluid responsiveness is essential in intensive care unit (ICU). However, most currently-used variables predicting the fluid responsiveness are invasive. This study is to evaluate the clinical value of the passive leg raising (PLR) test plus echocardiography in the prediction of the fluid responsiveness of patients with severe sepsis or septic shock.

方法: Methods A prospective study was conducted involving 62 patients treated in the intensive care unit (ICU) of The First Affiliated Hospital of Wannan Medical College from June 2013 to December 2015. All included patients had severe sepsis or septic shock and had been treated with mechanical ventilation. Semi-recumbent positioning, PLR, and a return to the semi-recumbent position were performed with all patients before volume expansion(VE). Echocardiography was used to monitor the brachial artery peak velocity variation (VVpeak_brach), brachial artery peak velocity (Vpeak_brach), and stroke volume (SV). A patient who showed an increase of ≥ 15% in the SV upon VE was defined as a responder. The ROC curve was used to evaluate the predictive value of VVpeak_brach and the variation in Vpeak_PLR and SV-PLR before and after the PLR; patients were monitored using echocardiography for their fluid responsiveness.

结果: Results A total of 28 patients were classified as responders. The area under the ROC curve for predicting the fluid responsiveness was 0.920, 0.898, and 0.891, respectively, for DSV-PLR, DVpeak_PLR, and VVpeak_brach. A DSV-PLR value of more than 12.45% predicted the fluid responsiveness with a sensitivity of 89.3% and a specificity of 88.2%. A DVpeak_PLR value of more than 10.6% predicted the fluid responsiveness with a sensitivity of 82.1% and a specificity of 88.2%. A VVpeak_brach value of more than 10.95% predicted the fluid responsiveness with a sensitivity of 78.6% and a specificity of 91.2%.

结论: Conclusion Variations in the SV, DVpeak_PLR, and VVpeak_brach before and after the PLR was monitored using echocardiography can be used to evaluate the fluid responsiveness in patients with septic shock.