AJRCCM Articles in Press. Published on 17-February-2017 as 10.1164/rccm.201701-0060LE
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Title: Can Passive Leg Raising Be Considered Gold Standard in Predicting Fluid Responsiveness? Simon T Vistisen1,2,3, Johannes Enevoldsen1,2, Thomas WL Scheeren3 1
Research Centre for Emergency Medicine, Aarhus University Hospitals, Denmark
2
Institute of Clinical Medicine, Aarhus University, Denmark
3
Department of Anaesthesiology, University Medical Centre Groningen, University of
Groningen, Groningen, the Netherlands
Communicating author: Simon Tilma Vistisen, PhD, MSc Email:
[email protected] Associate Professor, Research Centre for Emergency Medicine, Aarhus University Hospitals Nørrebrogade 44, Building 30, 1st floor, 8000 Aarhus C, Denmark +45 2067 6868 (Cell phone)
Simon T Vistisen, Johannes Enevoldsen and Thomas WL Scheeren have contributed entirely and equally to the content of this letter and revised and approved the final draft.
Short running title: Reliability of Passive Leg Raising
Word count, body: 570
Copyright © 2017 by the American Thoracic Society
AJRCCM Articles in Press. Published on 17-February-2017 as 10.1164/rccm.201701-0060LE
To the editor: We read with great interest the paper by Vignon and colleagues [1]. The study is second to none in the fluid responsiveness literature when it comes to number of patients included (540) and particularly when it comes to detailed high-quality echocardiographic evaluation. Still, the outstanding combination of study size and echocardiographic evaluation merits, or maybe even oblige, additional analyses to be reported, which appear straightforward based on the existing data: 1. The Passive leg raising (PLR) test defined fluid responsiveness in the study because PLR has demonstrated a nearly perfect fluid responsiveness prediction [2]. 229 patients got an evaluated fluid challenge and the ability of the echocardiographic measures and pulse pressure variation (PPV) to predict the actual fluid response was reported in the study’s supplemental data (table E4). However, the authors also had the largest cohort to date to evaluate the prediction ability of PLR. Since meta-analyses are inherently prone to limitations of publication bias and heterogeneity across studies, this unique chance for evaluating the “true” classification performance of PLR should not be missed. Yet, few data regarding PLR classification was reported: Mean increase of left ventricular stroke volume induced by fluid loading was markedly higher in patients with PLR which was indicative of fluid responsiveness (36±26% [n=161] vs. 5±17% [n=68]: p
