Changes in PPV Induced by PLR Test to Predict Fluid Responsiveness in ICU

NCT ID: NCT03225378

Last Updated: 2021-10-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Total Enrollment

286 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-09-21

Study Completion Date

2021-09-20

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The passive leg raising (PLR) test is a reversible preload challenge of around 300 mL of blood that can be repeated as frequently as required without infusing a drop of fluid. Two recent meta-analyses of many studies have confirmed the reliability of the PLR test to predict fluid responsiveness in patients with acute circulatory failure. Nevertheless, the effects of the PLR must be assessed by the direct measurement of cardiac output since changes in arterial pressure do not allow the assessment of the PLR hemodynamic effects with reliability. Moreover, cardiac output must be measured continuously and in real time.

In clinical practice, cardiac output measurement can be difficult for different reasons such as the unavailability of the echocardiography machine, or the absence of any continuous cardiac output monitoring technique at the time of acute circulatory failure occurrence.

Recently, it was shown that the decrease in pulse pressure variation (PPV) induced by the mini-fluid challenge (100 mL of colloid solution infused in 1 min) was able to predict fluid responsiveness with reliability in patients ventilated with low tidal volume (\<8 mL/kg of ideal body weight).

Therefore, the investigators hypothesize that the changes in PPV induced by PLR test could be able to predict fluid responsiveness with reliability in mechanically ventilated patients with acute circulatory failure.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Acute Circulatory Failure

Keywords

Explore important study keywords that can help with search, categorization, and topic discovery.

Fluid responsiveness Passive leg raising Pulse pressure variation

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Acute circulatory failure

Mechanically ventilated patients displaying acute circulatory failure in whom the physician decides to perform a fluid challenge (fluid loading of 500 mL of crystalloid solution) and a passive leg raising test to predict fluid responsiveness.

Fluid loading of 500 mL of crystalloid solution

Intervention Type OTHER

Infusion of 500 mL of crystalloid solution in less than 15 minutes

Passive Leg Raising test

Intervention Type OTHER

This intervention is done before the fluid loading in order to predict fluid responsiveness.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Fluid loading of 500 mL of crystalloid solution

Infusion of 500 mL of crystalloid solution in less than 15 minutes

Intervention Type OTHER

Passive Leg Raising test

This intervention is done before the fluid loading in order to predict fluid responsiveness.

Intervention Type OTHER

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Mechanically ventilated patients
* Patients in whom the physician decides to perform a fluid challenge based on the presence of one of the following criteria:

(1) systolic arterial pressure \<90 mmHg, mean arterial pressure \<65 mmHg, or the need for vasopressor infusion; (2) skin mottling; (3) urine output \<0.5 mL/Kg/h for more than or equal to 2 hours; (4) lactate concentrations \> 2 mmol/L
* Patients in whom the physician decides to perform a PLR test to predict fluid responsiveness
* Arterial catheter should be in place for invasive monitoring of arterial pressure and PPV


* Age \<18 yrs
* Pregnancy
* Moribund patients
* Risk of fluid loading induced pulmonary edema
* Cardiac arrhythmias
* Contraindication to perform PLR (intracranial hypertension, pelvic fractures)

Exclusion Criteria

* Changes in vasopressor and sedation agents dosages during the protocol
* Changes in ventilatory parameters during the protocol
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

Centre Hospitalier Arras

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Responsibility Role SPONSOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Jihad MALLAT, MD

Role: PRINCIPAL_INVESTIGATOR

Centre Hospitalier Arras

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

CHU d'Amiens - Réanimation Cardio-Thoracique-Vasculaire

Amiens, , France

Site Status

CHU d'Amiens - Réanimation chirurgicale

Amiens, , France

Site Status

Centre Hospitalier d'Arras

Arras, , France

Site Status

Centre Hospitalier de Béthune

Béthune, , France

Site Status

CH Boulogne-sur-mer

Boulogne-sur-Mer, , France

Site Status

CHU de Caen

Caen, , France

Site Status

Centre Hospitalier de Cambrai

Cambrai, , France

Site Status

CHU de Dijon

Dijon, , France

Site Status

Centre Hospitalier de Lens - Anesthésie-Réanimation

Lens, , France

Site Status

Centre Hospitalier de Lens - Réanimation

Lens, , France

Site Status

CHRU de Lille - Réanimation Médicale

Lille, , France

Site Status

CHU de Rouen

Rouen, , France

Site Status

Countries

Review the countries where the study has at least one active or historical site.

France

References

Explore related publications, articles, or registry entries linked to this study.

Monnet X, Marik P, Teboul JL. Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016 Dec;42(12):1935-1947. doi: 10.1007/s00134-015-4134-1. Epub 2016 Jan 29.

Reference Type RESULT
PMID: 26825952 (View on PubMed)

Cherpanath TG, Hirsch A, Geerts BF, Lagrand WK, Leeflang MM, Schultz MJ, Groeneveld AB. Predicting Fluid Responsiveness by Passive Leg Raising: A Systematic Review and Meta-Analysis of 23 Clinical Trials. Crit Care Med. 2016 May;44(5):981-91. doi: 10.1097/CCM.0000000000001556.

Reference Type RESULT
PMID: 26741579 (View on PubMed)

Mallat J, Meddour M, Durville E, Lemyze M, Pepy F, Temime J, Vangrunderbeeck N, Tronchon L, Thevenin D, Tavernier B. Decrease in pulse pressure and stroke volume variations after mini-fluid challenge accurately predicts fluid responsivenessdagger. Br J Anaesth. 2015 Sep;115(3):449-56. doi: 10.1093/bja/aev222. Epub 2015 Jul 6.

Reference Type RESULT
PMID: 26152341 (View on PubMed)

Mallat J, Abou-Arab O, Lemyze M, Saleh D, Guinot PG, Fischer MO. Changes in central venous-to-arterial PCO2 difference and central venous oxygen saturation as markers to define fluid responsiveness in critically ill patients: a pot-hoc analysis of a multi-center prospective study. Crit Care. 2024 Nov 8;28(1):360. doi: 10.1186/s13054-024-05156-y.

Reference Type DERIVED
PMID: 39516883 (View on PubMed)

Mallat J, Lemyze M, Fischer MO. Passive leg raising test induced changes in plethysmographic variability index to assess fluid responsiveness in critically ill mechanically ventilated patients with acute circulatory failure. J Crit Care. 2024 Feb;79:154449. doi: 10.1016/j.jcrc.2023.154449. Epub 2023 Oct 17.

Reference Type DERIVED
PMID: 37857068 (View on PubMed)

Mallat J, Fischer MO, Granier M, Vinsonneau C, Jonard M, Mahjoub Y, Baghdadi FA, Preau S, Poher F, Rebet O, Bouhemad B, Lemyze M, Marzouk M, Besnier E, Hamed F, Rahman N, Abou-Arab O, Guinot PG. Passive leg raising-induced changes in pulse pressure variation to assess fluid responsiveness in mechanically ventilated patients: a multicentre prospective observational study. Br J Anaesth. 2022 Sep;129(3):308-316. doi: 10.1016/j.bja.2022.04.031. Epub 2022 Jul 14.

Reference Type DERIVED
PMID: 35842352 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

2017_01

Identifier Type: -

Identifier Source: org_study_id