• Rui Shi, Francesca Moretto, Dominique Prat, Frederic Jacobs, Jean-Louis Teboul, and Olfa Hamzaoui.
• Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Le Kremlin-Bicêtre, France; INSERM-UMR_S999 LabEx - LERMIT, Hôpital Marie-Lannelongue, 92350 Le Plessis Robinson, France.
• J Crit Care. 2022 Dec 1; 72: 154141154141.

PurposeTo evaluate whether the changes in arterial pulse pressure (PP) and/or pulse pressure variation (PPV) during passive leg raising (PLR) can be used to evaluate preload responsiveness in patients with spontaneous breathing activity.Materials And MethodsPatients ventilated with pressure support mode or totally spontaneously breathing were prospectively included. The values of PP and PPV were recorded before and at the end of PLR. The changes in cardiac index (CI) or the velocity-time integral (VTI) of the left ventricular outflow tract during PLR were tracked by the pulse contour analysis or transthoracic echocardiography. Patients exhibiting an increase in CI ≥ 10% or VTI ≥ 12% during PLR were defined as preload responders.ResultsAmong 33 patients included, 28 (80%) received norepinephrine and 14 were preload responders. The increase in PP > 2 mmHg in absolute value (4% in percentage) during PLR (PLRPP) predicted preload responsiveness with an area under the receiver operating characteristic (AUROC) of 0.76 ± 0.09 (p = 0.003 vs. AUROC of 0.5). The changes in PPV during PLR, however, failed to predict preload responsiveness (p = 0.82 vs. AUROC of 0.5).ConclusionIn patients with full spontaneous breathing activity, PLR-induced changes in PP had a fair ability to assess preload responsiveness even when norepinephrine was administered.Registration NumberClinicalTrials.gov (NCT04369027).Copyright © 2022 Elsevier Inc. All rights reserved.

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