Velocity Time Integral vs PICCO for Evaluation of Passive Leg Raising in Septic Shock
Velocity Time Integral vs PICCO for Evaluation of Passive Leg Raising in Septic Shock
The objective of the present study is to investigate accuracy of changes in cardiac output
 following passive leg raising as estimated by transthoracic ultrasound as method to predict
 fluid responsiveness and compare that to changes in cardiac output following PLR as estimated
 by calibrated pulse contour analysis as method to predict fluid responsiveness in patients
 with septic shock.
One method to predict fluid responsiveness is to increase preload by transferring blood from
 the lower extremities to the central compartment through a passive leg raising (PLR) maneuver
 and then measure the resulting change in cardiac output. It was recently suggested that an
 increase in cardiac output following PLR had a high accuracy compared other methods to test
 fluid responsiveness. Different methods to estimate change in cardiac output have been used
 in studies investigating accuracy of PLR. Most commonly calibrated pulse contour analysis has
 been used in mechanically ventilated patients whereas transthoracic echocardiography (TTE)has
 been used in spontaneously breathing patients. While TTE offers the advantage of being less
 invasive than calibrated pulse contour analysis it is technically challenging and user
 dependent and the accuracy of the two methods has not been compared.
Inclusion Criteria:

 1. Septic shock according to the sepsis-3 criteria

 2. The treating physician plans to administer fluid to improve organ perfusion and
 oxygenation due to signs of inadequate organ perfusion and hypoxia (skin mottling,
 tachycardia (>100), urine output below 0.5 ml/kg/h, lactate persistently > 2 mmol/l
 and central venous oxygen saturation < 70%, increasing doses of vasoconstrictors to
 maintain mean arterial pressure >65 mmHg.

 3. Hemodynamic monitoring with transpulmonary thermodilution initiated as part of routine
 clinical monitoring.

 Exclusion Criteria:

 1. Any condition that will affect the reliability of the PLR procedure or is a
 contraindication to PLR (compression stockings or intraabdominal pressure > 12 mm Hg,
 raised intracranial pressure).

 2. PaO2/FiO2 < 100 mmHg (13.3 kPa) or suspicion of cardiogenic edema

 3. Transthoracic echo does not allow recording of VTI.

 4. Age >18 years.

 5. No informed consent

 6. Prior inclusion in the study