Using the physical examination to predict response to fluid bolus.

This post, and the last post to ClinDx about heart failure, use the physical examination not as a traditional diagnostic test, but rather to help predict response to treatment.

The current study shows that an increase of pulse pressure of ≥ 9% (as measured by a radial artery catheter) can predict an increase in stroke volume after 500 cc of  6% hydroxyethyl starch among patients with severe sepsis or pancreatitis.  The differences in the areas under the ROC curves were no significantly different among the three findings in the table.

Predicting increase in cardiac stroke volume after intravenous infusion of 500 cm of fluids
Finding after passive leg raising Sensitivity Specificity
Increase ≥ 9% in pulse pressure as measured by radial arterial catheter 79% 85%
Increase ≥ 8% in femoral artery blood flow as measured by Doppler ultrasonography 86% 80%
Increase ≥ 10% in stroke volume as measured by bedside echocardiography 86% 90%

A limitation is that the pulse pressure was measured by radial artery catheter. Presumably, an auscultated blood pressure would perform similarly, but this is not certain.

This has been added to http://en.citizendium.org/wiki/Head-down_tilt.

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