Original article Brachial cuff measurements of blood pressure during passive leg raising for fluid responsiveness prediction Pre ´diction de la re ´ponse au remplissage vasculaire par la mesure de la pression arte ´rielle au brassard lors du lever de jambes K. Lakhal a, *, S. Ehrmann b , D. Benzekri-Lefe ` vre c , I. Runge c , A. Legras b , P.-F. Dequin b , E. Mercier b , M. Wolff a , B. Re ´ gnier a , T. Boulain c a Service de re ´animation me ´dicale et maladies infectieuses, ho ˆpital Bichat-Claude Bernard, Assistance publique–Hoˆpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris cedex 18, France b Service de re ´animation me ´dicale polyvalente, CHRU de Tours, 37044 Tours, France c Service de re ´animation me ´dicale, ho ˆpital La Source, centre hospitalier re ´gional, avenue de l’Ho ˆpital, 45067 Orle ´ans cedex 1, France Annales Franc ¸aises d’Anesthe ´ sie et de Re ´ animation 31 (2012) e67–e72 A R T I C L E I N F O Article history: Received 11 July 2011 Accepted 10 January 2012 Keywords: Monitoring Physiologic Hypovolemia Passive leg raising Preload Central venous pressure Noninvasive blood pressure determination Oscillometry Mots cle ´s: Monitorage Physiologie Hypovole ´ mie Lever de jambes Pre ´ charge A B S T R A C T Objective. – The passive leg raising maneuver (PLR) for fluid responsiveness testing relies on cardiac output (CO) measurements or invasive measurements of arterial pressure (AP) whereas the initial hemodynamic management during shock is often based solely on brachial cuff measurements. We assessed PLR-induced changes in noninvasive oscillometric readings to predict fluid responsiveness. Study design. – Multicentre interventional study. Patients and methods. – In ICU sedated patients with circulatory failure, AP (invasive and noninvasive readings) and CO measurements were performed before, during PLR (trunk supine, not modified) and after 500-mL volume expansion. Areas under the ROC curves (AUC) were determined for fluid responsiveness (> 10% volume expansion-induced increase in CO) prediction. Results. – In 112 patients (19% with arrhythmia), changes in noninvasive systolic AP during PLR (noninvasiveD PLR SAP) only predicted fluid responsiveness (cutoff 17%, n = 21, positive likelihood ratio [LR] of 26 [18–38]), not unresponsiveness. If PLR-induced change in central venous pressure (CVP) was at least of 2 mmHg (n = 60), suggesting that PLR succeeded in altering cardiac preload, noninvasiveD PLR SAP performance was good: AUC of 0.94 [0.85–0.98], positive and negative LRs of 5.7 [4.6–6.8] and 0.07 [0.009–0.5], respectively, for a cutoff of 9%. Of note, invasive AP-derived indices did not outperform noninvasiveD PLR SAP. Conclusion. – Regardless of CVP (i.e., during ‘‘blind PLR’’), noninvasiveD PLR SAP more than 17% reliably identified fluid responders. During ‘‘CVP-guided PLR’’, in case of sufficient change in CVP, noninvasi- veD PLR SAP performed better (cutoff of 9%). These findings, in sedated patients who had already undergone volume expansion and/or catecholamines, have to be verified during the early phase of circulatory failure (before an arterial line and/or a CO measuring device is placed). ß 2012 Socie ´ te ´ franc ¸aise d’anesthe ´ sie et de re ´ animation (Sfar). Published by Elsevier Masson SAS. All rights reserved. R E ´ S U M E ´ Objectif. – Pour pre ´ dire la re ´ ponse au remplissage vasculaire (RV), le lever de jambes (LJ) ne ´ cessite la mesure concomitante du de ´ bit cardiaque (DC) ou de la pression arte ´ rielle (PA) invasive. Or, les soins initiaux du patient en choc reposent souvent uniquement sur la mesure non-invasive, oscillome ´ trique, de la PA, dont nous avons e ´ value ´ le pouvoir pre ´ dictif. Type d’e ´tude. – Multicentrique, interventionnelle. Patients et me ´thodes. – Chez des patients se ´ date ´ s, en insuffisance circulatoire, PA (invasive et non- invasive) et DC e ´ taient mesure ´s avant, pendant LJ (tronc horizontal, immobile) puis apre `s RV. La re ´ ponse au RV e ´ tait de ´ finie comme une augmentation du DC supe ´ rieure a ` 10 %. * Corresponding author. E-mail address: lakhal_karim@yahoo.fr (K. Lakhal). Available online at www.sciencedirect.com 0750-7658/$ – see front matter ß 2012 Socie ´te ´ franc ¸aise d’anesthe ´ sie et de re ´ animation (Sfar). Published by Elsevier Masson SAS. All rights reserved. doi:10.1016/j.annfar.2012.01.032