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

Assessing Passive Leg Raise Test in Pediatric Shock Using Electrical Cardiometry

Angela Pham
1   Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
2   Department of Pediatrics, Texas A&M University, College Station, Texas, United States
,
Nikhil R. Shah 
3   Department of Surgery, University of Texas Medical Branch, Galveston, Texas, United States
,
Shreya Chandran
1   Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
,
Patrick Fueta
1   Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
2   Department of Pediatrics, Texas A&M University, College Station, Texas, United States
,
Estela O'Daniell
4   Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
,
Jessica Burleson
4   Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
,
Sarah Cottingham
4   Department of Emergency Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
,
Halil Sari
6   Department of Medical Education, Texas A&M University, College Station, Texas, United States
,
Ravi S. Samraj
1   Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
5   Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
,
Utpal Bhalala   *
1   Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, Texas, United States
2   Department of Pediatrics, Texas A&M University, College Station, Texas, United States
5   Department of Anesthesiology and Critical Care Medicine, Driscoll Children's Hospital, Corpus Christi, Texas, United States
› Author Affiliations Funding The first author Angela Pham was supported through Texas A&M University Medical Student Research Pathway Program Scholarship for this research project at Driscoll Children's Hospital.
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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

Previous Presentation

The abstract was presented as a podium presentation at the 2023 Critical Care Congress: Annual Meeting in San Francisco, CA (January 21–24, 2023).


* Dr. Bhalala was affiliated with Driscoll Children's Hospital & Texas A & M University during study period and now affiliated with Amistad Health.




Publication History

Received: 17 June 2023

Accepted: 20 November 2023

Article published online:
26 December 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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