passive leg raising can predict fluid responsiveness in patients placed on venovenous extracorporeal membrane oxygenation被动的腿提高预测病人对液体放在venovenous体外膜氧合.pdfVIP

Guinot et al. Critical Care 2011, 15:R216 /content/15/5/R216 RESEARCH Open Access Passive leg raising can predict fluid responsiveness in patients placed on venovenous extracorporeal membrane oxygenation 1* 1 1 1 1 1 Pierre-Grégoire Guinot , Elie Zogheib , Mathieu Detave , Mona Moubarak , Vincent Hubert , Louise Badoux , 1 1 2,3 1,3 Eugénie Bernard , Patricia Besserve , Thierry Caus and Hervé Dupont Abstract Introduction: In ICUs, fluid administration is frequently used to treat hypovolaemia. Because volume expansion (VE) can worsen acute respiratory distress syndrome (ARDS) and volume overload must be avoided, predictive indicators of fluid responsiveness are needed. The purpose of this study was to determine whether passive leg raising (PLR) can be used to predict fluid responsiveness in patients with ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO). Methods: We carried out a prospective study in a university hospital surgical ICU. All patients with ARDS treated with venovenous ECMO and exhibiting clinical and laboratory signs of hypovolaemia were enrolled. We measured PLR-induced changes in stroke volume (ΔPLRSV) and cardiac output (ΔPLRCO) using transthoracic echocardiography. We also assessed PLR-induced changes in ECMO pump flow (ΔPLRPO) and PLR-induced changes in ECMO pulse pressure (ΔPLRPP) as predictors of fluid responsiveness. Responders were defined by an increase in stroke volume (SV) 15% after VE. Results: Twenty-five measurements were obtained from seventeen patients. In 52% of the measurements (n = 13), SV increased by 15% after VE (responders). The pa