Haemodynamics, fluids & transfusion
Assessing fluid responsiveness in mechanically ventilated patients with intra-abdominal hypertension: a two-center, prospective, observational study
Authors' conclusion
In patients with IAH, the limited diagnostic value of PLR for fluid responsiveness may be related to persistently negative CVP-IAP gradients in false-negative cases, whereas EEO and mini-fluid challenge remain reliable alternatives.
Study context
- Population
- Mechanically ventilated ICU patients monitored by transpulmonary thermodilution receiving a 500-mL fluid challenge
- Participants
- 88 participants · 2 intensive care units (ICUs)
- Comparison
- Intra-abdominal hypertension (IAH)- vs IAH +
- IAH-n = 44reference
- IAH +n = 44
- Outcome
- Diagnostic accuracy (AUROC) of PLR, EEO and mini-fluid challenge for fluid responsiveness (≥ 15% CI increase after 500 mL)
Methodological detailsprospective, observational, two-center
- Prospective
- Observational
- Two-center
Performance
As reported in the abstract
AUROC for detecting fluid responsiveness
| Test or model | Passive leg raising (PLR) AUROC | End-expiratory occlusion (EEO) AUROC | Mini-fluid challenge AUROC |
|---|---|---|---|
| IAH- | 0.96 (0.87-1.00) | 0.95 [0.87-1.00] | 0.94 [0.87-1.00] |
| IAH + | 0.71 (0.56-0.87) | 0.89 [0.80-0.97] | 0.90 [0.79-1.00] |
Passive leg raising (PLR) AUROC
IAH-0.96 (0.87-1.00)
IAH +0.71 (0.56-0.87)
End-expiratory occlusion (EEO) AUROC
IAH-0.95 [0.87-1.00]
IAH +0.89 [0.80-0.97]
Mini-fluid challenge AUROC
IAH-0.94 [0.87-1.00]
IAH +0.90 [0.79-1.00]
- IAH + vs IAH-: P = 0.009
- IAH + vs IAH-: P = 0.332 — similar
- IAH + vs IAH-: P = 0.514 — similar
Further findings
Baseline IAP
P < 0.001
CI increase during PLR (responders)
P < 0.001
PLR positive IAH- 24/25 responders
CI increase after volume expansion (responders)
P = 0.907
CVP-IAP gradient during PLR in IAH + (16 false negatives, 6 true positives)
- True positives: from −2.4 ± 4.0 to + 2.2 ± 2.7 mmHg (reversed)
- P = 0.014
- False negatives: from −6.3 ± 3.7 to −1.4 ± 3.4 mmHg (remained negative)
- P < 0.001
- Both with negative baseline CVP-IAP gradients
Original publication
Assessing fluid responsiveness in mechanically ventilated patients with intra-abdominal hypertension: a two-center, prospective, observational study. Crit Care. Published 17 July 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →