Publication: The effects of passive leg raising test and fluid challenge on central venous pressure and cardiac output to assess fluid responsiveness in intensive care unit
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Date
2020
Authors
Thevadass, Shubashini
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Abstract
Background: The use of central venous pressure (CVP) as a hemodynamic variable to monitor fluid responsiveness is still popular, although numerous studies have refuted its use in the intensive care unit (ICU). Despite its discredit, in this study we aim to determine the effectiveness of monitoring central venous pressure (CVP) changes to cardiac Methods: output (CO) changes and its correlation during passive leg raising (PLR) and after volume expander (VE), with the aid of FloTrac/Vigileo, a non-invasive CO monitoring system.
Methods: This prospective, interventional study evaluated 37 patients in the general ICU and surgical ICU. All 37 patients were septic, mechanically ventilated and were planned for fluid bolus. All fitted to the FLoTrac/Vigileo system and recordings of CVP and CO taken at baseline, after PLR, before and after VE. Fluid responders were defined as ΔcoVE >13%.
Results: CVP and CO changes during PLR and after VE both were significant (P<0.001). The correlation coefficient of ΔcvpPLR with ΔcvpVE, ΔcvpPLR with ΔcoPLR, ΔcvpPLR with ΔcoVE was 0.146 (P=0.388), 0.046 (P=0.788) and 0.128 (P=0.452) respectively. The hemodynamic changes for before and after VE were significant for heart rate (HR) and mean arterial pressure (MAP) with (P=0.013 and P<0.001) respectively. Both HR and MAP were not significant before and after PLR (P=0.720, P=0.620).
Conclusion: The usage of FloTrac/Vigileo system to assess changes in CVP in comparison to CO changes might not be accurate as revealed by our study which showed no correlation.