Impact of body size on stroke volume response to passive leg raising in spontaneously breathing children

Ocaña-Alcober, Carlos ; Oulego-Erroz, Ignacio ; Palanca-Arias, Daniel (Universidad de Zaragoza) ; Alonso-Ojembarrena, Almudena ; Menéndez-Suso, Juan José ; Vázquez-Martínez, José Luis

Resumen: OBJECTIVES: To test whether indexing stroke volume change (ΔSV%) to body size during the passive leg raising (PLR) test in spontanoeusly breathing children improves accuracy to detect fluid responsiveness (FR). DESIGN: Observational study. SETTING: Two pediatric hospitals. PATIENTS: Children age 2-16 years.None. MEASUREMENTS AND MAIN RESULTS: In study phase 1, we measured ΔSV% by echocardiography during PLR in healthy children. A positive PLR test was defined as a mean ΔSV% greater than or equal to 10%. The correlation between ΔSV% with body size parameters was assessed, and optimal body size indexation was generated. In study phase 2, the PLR was performed in acutely ill children before a fluid challenge of 20 mL/kg of normal saline. ΔSV% was measured at 10 and 20 mL/kg and FR was defined as ΔSV% greater than or equal to 10% or greater than or equal to 15% (four possible definitions of FR). The diagnostic performance of the PLR using nonindexed and indexed ΔSV% to identify FR was assessed using the area under the receiver operating characteristic curve (AUC) analyses. We recruited 133 and 87 children in phase 1 and 2, respectively. Mean ΔSV% and the proportion of positive PLR test increased with age tertiles both in healthy children and children receiving a fluid challenge ( p ≤ 0.01). ΔSV% positively correlated with body size. Indexing by height (i.e., [ΔSV%/0.0006] × height 2.493 ) removed the effect of body size. The AUC of the PLR for FR ranged from 0.745 to 0.802, depending on the FR definition applied. The use of height-indexed ΔSV% improved diagnostic performance (AUC range, 0.852-0.894) compared to non-indexed ΔSV%, although the result was significant only when FR was defined as ΔSV% greater than 15% after 20 mL/kg (DeLong test < 0.05). CONCLUSIONS: The response in ΔSV% to a PLR is greatly influenced by body size. Indexing the value by height may improve the diagnostic performance of the PLR in children. Copyright © 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

Idioma: Inglés

DOI: 10.1097/PCC.0000000000003828

Año: 2025

Publicado en: Pediatric Critical Care Medicine 26, 12 (2025), e1457-e1466 [10 pp.]
ISSN: 1529-7535

Tipo y forma: Article (PostPrint)

Área (Departamento): Área Pediatría (Dpto. Microb.Ped.Radio.Sal.Pú.)