Critical Care: Sepsis I |

Passive Leg Raise Prediction of Fluid Responsiveness Using Nicom and Flotrac Devices in Septic Shock: Preliminary Findings FREE TO VIEW

Yuri Matusov, MD; Priyanka Saharan, MD; Wing Sun Tam, MD; Connor Johnson, MD; Jonathan Grotts, MA; Jeffrey Fried, MD
Author and Funding Information

Santa Barbara Cottage Hospital, Santa Barbara, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):354A. doi:10.1016/j.chest.2016.08.367
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: To compare the minimally-invasive Edwards FloTrac with the newer, noninvasive Cheetah NICOM for measuring cardiac output and stroke volume during passive leg raises (PLRs) as predictors of volume responsiveness in patients with septic shock.

METHODS: This was an IRB approved, prospective, open-label, single-arm pilot study of adult patients admitted to the medical intensive care unit at Santa Barbara Cottage Hospital with severe sepsis and septic shock. Each patient was monitored with the FloTrac and NICOM during serial PLRs. Following initial resuscitation with at least 30ml/kg crystalloid, the patient was considered likely to be fluid responsive (PLR positive) with an increase of > 10% in cardiac index (CI), stroke volume index (SVI) (by either device) or pulse pressure. After the initial PLR all patients were given a fluid bolus of > 500ml. Subsequently, patients were given fluid only if the PLR was positive or if the treating team felt a bolus was clinically appropriate, and the hemodynamic parameters re-checked for improvement. Statistical analysis was performed to determine the ability of each device to predict fluid responsiveness to the subsequent bolus.

RESULTS: This is a preliminary report on the first 13 patients of a planned 50 enrolled into the clinical trial (46.2% female, median age 75 years, 32 total fluid boluses given). The NICOM device was more sensitive for predicting fluid responsiveness than the FloTrac by both CI and SVI (61.5% and 62.5% vs 28.6% and 42.9%, respectively), and had a greater positive predictive value (42.1% and 52.6% vs 28.6% and 33.3%, respectively). The FloTrac device, however, had a higher negative predictive value than the NICOM for both CI and SVI (80% and 82.6% vs 61.5% and 53.8%, respectively). The NICOM had a positive predictive value of 50% for mean arterial pressure increase of >10% following fluid administration.

CONCLUSIONS: Neither the NICOM nor the FloTrac had excellent positive predictive value of CI and SVI change as related to subsequent fluid administration, in this preliminary report. The FloTrac may be better than the NICOM for ruling out the need for fluid administration. Further data are needed to adequately power these conclusions and to correlate the utility of each monitoring device to clinical significance.

CLINICAL IMPLICATIONS: There remains a need for reliable, validated minimally-invasive or noninvasive monitor of hemodynamics to guide fluid resuscitation in septic shock. This preliminary report suggests that neither of the tested devices is particularly reliable for predicting fluid responders, but more data is needed before a conclusive judgment may be passed. Clinicians should continue to explore parameters which could guide fluid resuscitation.

DISCLOSURE: The following authors have nothing to disclose: Yuri Matusov, Priyanka Saharan, Wing Sun Tam, Connor Johnson, Jonathan Grotts, Jeffrey Fried

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