J Anesth Perioper Med. 2017;4(4):169-178. https://doi.org/10.24015/ebcmed.japm.2017.0049
From the 1Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; 2Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden; 3Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden; 4Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia; 5The University of Texas Medical Branch UTMB Health, Department of Anesthesiology, John Sealy Hospital, Galveston, USA.
Correspondence to Correspondence to Dr. Maria Cronhjort at maria.cronhjort@sll.se.
EBCMED ID: ebcmed.japm.2017.0049 DOI: 10.24015/ebcmed.japm.2017.0049
Background
Several observational studies have demonstrated an association between fluid accumulation and mortality in sepsis. Our aim was to determine if assessment of fluid responsiveness by a passive leg raising (PLR) algorithm could reduce fluid accumulation after 3 days in the intensive care unit (ICU) in patients with septic shock.
Methods
This was an open-label single-centre randomised clinical trial performed in a surgical ICU in a tertiary centre in Stockholm, Sweden. We randomised adult (>18 years) patients with septic shock admitted to the ICU to a PLR group or a standard of care group. An increase in stroke volume index of at least 10% on the PLR test was required for the clinician to administer a fluid bolus to patients in the PLR group.
Results
We randomised 34 patients. The mean (SD) weight gain after three full ICU-days was 0.6 ± 3.2 kg in the PLR group and 1.3 ± 3.9 kg in the control group (P = 0.59). The median (IQR) amount of administered resuscitation fluid during the study period was 2103 (1283-2645) ml in the PLR group and 2408 (954-5045) ml in the control group (P = 0.38). We could implement a protocol that required a positive PLR-test before administration of resuscitation fluids, but recruitment rate was low. The trial was terminated early for futility.
Conclusions
The PLR protocol was not meaningful in our clinical setting, as weight gain was already low in the control group. To increase feasibility of a trial which implements a PLR-test we recommend using a non-invasive hemodynamic measurement, to include restriction of maintenance fluids in the protocol and to investigate the level of weight gain in the setting where the trial is to be performed before the start of the trial. (Funded by Stockholm County Council; ClinicalTrials.gov number, NCT02301585.)
Article Type
Original Article
Declaration of Interests
The authors have no other potential conflicts of interest for this work.
Acknowledgements
This study was supported by a research grant from the Stockholm County Council (Grant Number: 20130312).
The authors thank the clinical staff at the ICU of Södersjukhuset who made this trial possible by their willingness to adopt new ideas.
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