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The following is a summary of “Changes in pulse pressure variation induced by passive leg raising test to predict preload responsiveness in mechanically ventilated patients with low tidal volume in ICU: a systematic review and meta-analysis,” published in the January 2025 issue of Critical Care by Mallat et al.
Researchers conducted a retrospective study to specify if passive leg raising (PLR)-induced changes in pulse pressure variation (PPV) could reliably predict preload or fluid responsiveness in individuals on mechanical ventilation receiving low tidal volume in the intensive care unit.
They screened PubMed, Embase, and Cochrane databases for diagnostic studies on the predictability of PPV changes after PLR in individuals with low-tidal volume and mechanically ventilated. The QUADAS-2 scale evaluated the risk of bias, while heterogeneity among studies was analyzed using the I2 indicator. Publication bias was examined with the Deeks’ funnel plot asymmetry test, and pooled sensitivity, specificity, and the summary receiver operating characteristic curve (SROC) were estimated.
The results showed 5 studies involving 474 individuals. The SROC for absolute PPV change had an area under the curve of 0.91 (95% CI 0.88–0.93). Pooled sensitivity and specificity were 0.88 (95% CI 0.82–0.91) and 0.83 (95% CI 0.76–0.89), respectively, with a diagnostic odds ratio of 35 (95% CI 19–67). The mean and median cutoff values for PLR-induced absolute PPV change were -2 points, ranging from -2.5 to -1 points. Heterogeneity was minimal (I2= 0%), and no significant publication bias was observed. Fagan’s nomogram indicated post-test probabilities of 84% for positive tests and 17% for negative tests, with a 50% pre-test probability.
Investigators concluded the PLR-induced changes in absolute PPV showed good diagnostic performance for predicting fluid responsiveness in individuals in the ICU receiving mechanical ventilation with low tidal volumes.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05238-x
