Title:Does Fluid Administration Based on Fluid Responsiveness Tests such as
Passive Leg Raising Improve Outcomes in Sepsis?
Volume: 18
Issue: 5
Author(s): Kenneth Nugent*, Gilbert Berdine and Camilo Pena
Affiliation:
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock Texas, USA
Keywords:
Sepsis, fluid responsiveness, passive leg raising, norepinephrine, hypotension, hemodynamic parameters.
Abstract: The management of sepsis requires the rapid administration of fluid to support blood
pressure and tissue perfusion. Guidelines suggest that patients should receive 30 ml per kg of fluid
over the first one to three hours of management. The next concern is to determine which patients
need additional fluid. This introduces the concept of fluid responsiveness, defined by an increase
in cardiac output following the administration of a fluid bolus. Dynamic tests, measuring cardiac
output, identify fluid responders better than static tests. Passive leg raising tests provide an alternative
approach to determine fluid responsiveness without administering fluid. However, one small
randomized trial demonstrated that patients managed with frequent passive leg raising tests had a
smaller net fluid balance at 72 hours and reduced requirements for renal replacement therapy and
mechanical ventilation, but no change in mortality. A meta-analysis including 4 randomized control
trials reported that resuscitation guided by fluid responsiveness does not improve mortality
outcomes in patients with sepsis. Recent studies have demonstrated that the early administration of
norepinephrine may improve outcomes in patients with sepsis. The concept of fluid responsiveness
helps clinicians analyze the clinical status of patients, but this information must be integrated into
the overall management of the patient. This review considers the use and benefit of fluid responsiveness
tests to direct fluid administration in patients with sepsis.
