Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

Angela Pham; Nikhil R. Shah; Shreya Chandran; Patrick Fueta; Estela O'Daniell; Jessica Burleson; Sarah Cottingham; Halil Sari; Ravi S. Samraj; Utpal Bhalala

doi:10.1055/s-0043-1777798

Journal of Pediatric Intensive Care, Table of Contents

J Pediatr Intensive Care
DOI: 10.1055/s-0043-1777798

Original Article

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

Authors

Angela Pham

¹Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States

²Department of Pediatrics, Texas A&M University, College Station, Texas, United States
Nikhil R. Shah

³Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States
Shreya Chandran

¹Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
Patrick Fueta

¹Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States

²Department of Pediatrics, Texas A&M University, College Station, Texas, United States
Estela O'Daniell

⁴Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
Jessica Burleson

⁴Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
Sarah Cottingham

⁴Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
Halil Sari

⁶Department of Medical Education, Texas A&M University, College Station, Texas, United States
Ravi S. Samraj

¹Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States

⁵Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
Utpal Bhalala^*

¹Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States

²Department of Pediatrics, Texas A&M University, College Station, Texas, United States

⁵Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States

Abstract

Passive leg raise (PLR) is widely used to incite an autobolus to assess fluid responsiveness in adults; however, there is a paucity of studies exploring its utility in children. Our study aimed to analyze the efficacy of PLR in determining fluid responsiveness in children presenting with shock using electrical cardiometry. Patients in the age group of 0 to 20 years who presented in shock to our children's hospital emergency department were evaluated. Multiple hemodynamic metrics including, heart rate, systolic/diastolic blood pressure, cardiac output (CO), stroke index, stroke volume (SV), flow time corrected (FTC), and left ventricular ejection time (LVET) were recorded using the noninvasive ICON device and compared at baseline and post-PLR. A total of 68 patients had pre- and post-PLR data available for review between June and July 2022. Median age was 7 years (54% male); most common etiology was hypovolemic (67.6%) shock. Following PLR, there was no significant change in most hemodynamic parameters, including SV and CO; however, there was a significant difference in FTC (301 [pre-PLR] vs. 307 [post-PLR], p = 0.016) (ms) and LVET (232 [pre-PLR] vs. 234 [post-PLR], p = 0.014) (ms). A significantly higher proportion of children diagnosed with septic shock demonstrated fluid responsiveness (ΔSV ≥ 10% from baseline) compared with those with hypovolemic shock (p = 0.036). This study demonstrated no identifiable fluid responsiveness (ΔSV ≥ 10% from baseline) following PLR; however, a significantly higher proportion of children suffering from septic shock demonstrated fluid responsiveness compared with those with hypovolemic shock. Larger studies are needed to further assess the utility of PLR, as well as other modalities, in determining fluid responsiveness in children.

Keywords

passive leg raise - fluid responsiveness - hemodynamic monitoring - NICOM - emergency department

Full Text

References

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