• Jihad Mallat, Marc-Olivier Fischer, Maxime Granier, Christophe Vinsonneau, Marie Jonard, Yazine Mahjoub, Fawzi Ali Baghdadi, Sébastien Préau, Fabien Poher, Olivier Rebet, Belaid Bouhemad, Malcolm Lemyze, Mehdi Marzouk, Emmanuel Besnier, Fadi Hamed, Nadeem Rahman, Osama Abou-Arab, and Pierre-Grégoire Guinot.
• Department of Critical Care Medicine, Arras Hospital, Arras, France; Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Normandy University, UNICAEN, Ecole Doctorale NBISE 497, Caen, France. Electronic address: mallatjihad@gmail.com.
• Br J Anaesth. 2022 Sep 1; 129 (3): 308-316.

BackgroundPassive leg raising-induced changes in cardiac index can be used to predict fluid responsiveness. We investigated whether passive leg raising-induced changes in pulse pressure variation (ΔPPVPLR) can also predict fluid responsiveness in mechanically ventilated patients.MethodsIn this multicentre prospective observational study, we included 270 critically ill patients on mechanical ventilation in whom volume expansion was indicated because of acute circulatory failure. We did not include patients with cardiac arrythmias. Cardiac index and PPV were measured before/during a passive leg raising test and before/after volume expansion. A volume expansion-induced increase in cardiac index of >15% defined fluid responsiveness. To investigate whether ΔPPVPLR can predict fluid responsiveness, we determined areas under the receiver operating characteristic curves (AUROCs) and grey zones for relative and absolute ΔPPVPLR.ResultsOf the 270 patients, 238 (88%) were on controlled mechanical ventilation with no spontaneous breathing activity and 32 (12%) were on pressure support ventilation. The median tidal volume was 7.1 (inter-quartile range [IQR], 6.6-7.6) ml kg-1 ideal body weight. One hundred sixty-four patients (61%) were fluid responders. Relative and absolute ΔPPVPLR predicted fluid responsiveness with an AUROC of 0.92 (95% confidence interval [95% CI], 0.88-0.95; P<0.001) each. The grey zone for relative and absolute ΔPPVPLR included 4.8% and 22.6% of patients, respectively. These results were not affected by ventilatory mode and baseline characteristics (type of shock, centre, vasoactive treatment).ConclusionsPassive leg raising-induced changes in pulse pressure variation accurately predict fluid responsiveness with a small grey zone in critically ill patients on mechanical ventilation.Clinical Trial RegistrationNCT03225378.Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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