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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, June 1, 2013

Elevación de las piernas: predicción de respuesta a fluidos

Passive leg raise offers promise in predicting fluid responsiveness (Chest)
PulmCCM March 24, 2013 - CHEST, Critical care, Infectious Disease and Sepsis, Mechanical Ventilation
Passive Leg Raise Improved Management of Patients in Shock*(*some assembly required) - by Blair Westerly, MD

"Only 50% of hemodynamically unstable patients are volumen responsive, but we need something better than just a coin flip to determine who should receive fluids and who shouldn’t. Lifting a patient´s legs has been estimated to provide a 200-300 mL bolus of fluid, by mobilizing pooled venous blood back to the heart. Marik and colleagues Marik and asked whether this quick and easy test was also accurate at identifying patients whose blood pressure would improve with IV fluids, reporting their findings in a recent issue of Chest."
"Clinical Takeaway: When trying to ascertain a patient’s fluid responsiveness, our current choices are gestalt (i.e., high uncertainty) and an invasive pulmonary artery catheter of doubtful benefit and possible harm. Using passive leg raise as a test routinely could help, and it’s hard to see how it could hurt..."
Ref: The use of bioreactance and carotid Doppler to determine volume responsiveness and bloodflow redistribution following passive leg raising in hemodynamically unstable patients.  Marik, PE et al. Chest 2013; 143(2): 364-370