The Role Of Passive Leg Raising To Predict

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THE ROLE OF PASSIVE LEG RAISING
TO
PREDICT
FLUID
RESPONSIVENESS IN PEDIATRIC
INTENSIVE CARE UNIT PATIENTS
LUKITO V , DJER MM , PUDJIADI AH , MUNASIR Z
PEDIATR CRIT CARE MED 2012 VOL. 13, N° 3

Residência médica em UTI Pediátrica – HIJG
R3 Mariana





A elevação passiva das pernas é uma manobra que pode aumentar a pré-carga rapidamente por autotransfusão de sangue dos membros inferiores.

pré-carga enchimento do VE

enchimento do VD
Débito Cardíaco



Em adultos a manobra de elevação passiva das pernas é usada como preditor de fluido-responsividade com sensibilidade de 89,4% e especificidade de 91,4% demonstradas em uma revisão sistemática publicada por Callavaro et al. na Intensive Care Med 2010.

MÉTODOS


Estudo conduzido por 3 meses, de junho a agosto de
2010 em uma UTI pediátrica em um hospital universitário de nível terciário na Indonésia



Critérios de inclusão: crianças de 1-13 anos
Critérios de exclusão: crianças que tivessem contraindicações a administração de fluidos em bolus e contra-indicações à elevação das pernas (aumento da
PIC, fraturas de extremidades inferiores) e pacientes com diagnóstico de choque que precisavam de expansão volêmica agressiva.



MÉTODOS


Foram mensurados parâmetros hemodinâmicos: FC, PA,
VS, IC antes da manobra de elevação das pernas por 10 min e após 5 min desta, antes da adm. de SF0,9% 10 ml/kg (por 15 min) e imediatamente após ( VS e IC foram avaliados através de ecocardiografia trasntorácica)



Foram considerados respondedores tiveram aumento do IC em > 10%.

pacientes

que



Pacientes internados no período: 119



Amostra final: 40 pacientes



Diagnósticos heterogêneos (pós-operatório, dengue hemorrágica, sepse, neoplasias, problemas respiratórios, neurológicos e hematológicos) 

Necessitaram de inotrópicos: 3%



Necessitaram de VM: 11%



Mediana de idade: 6 anos (1-13ª)



Fem: 57,5% / Masc: 42,5%

RESULTADOS



As mudanças em parâmetros hemodinâmicos que foram
consideradas

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