End expiratory occlusion test for evaluation of fluid responsiveness in comparison to passive leg raising test in mechanically ventilated post cardiac surgery patients : a randomized clinical trial

Document Type : Original Article

Authors

1 Anesthesia and critical care and pain management, Faculty of medicine, Ain Shams University

2 Anaesthesiology, Intensive Care and Pain Management, Faculty of medicine, Ain Shams University

Abstract

Background
Fluid responsiveness evaluation is critical for hemodynamic optimization in patients receiving ventilator support following cardiac surgery. The end-expiratory occlusion test (EEOT) and passive leg raising (PLR) tests are dynamic methods used for this purpose, but their comparative efficacy remains debated.

Methodology: 46 adult patients after heart surgery were recruited in this sequential clinical research. Prior to and following the EEOT and the PLR test, hemodynamic measures such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure variation (PPV), and central venous pressure (CVP) were measured. Responders defined by PPV decrease with cut off 5% in EEO test and cut off at least 10% in PLR test .


Results: In the end-expiratory occlusion test, 24 individuals (52.2%) responded. While 27 patients (58.7%) responded to the PLR test. Both tests showed significant increase in SBP, DBP, MAP(P < 0.05), and decrease in PPV% ( P < 0.05). ROC analysis revealed AUCs of 0.875 (SBP, EEOT) and 0.895 (SBP, PLRT) indicating good predictive performance.

Conclusion: While both tests reliably predict fluid responsiveness, PLR test demonstrated numerically higher responder rates and greater hemodynamic changes than EEOT, though not statistically significant between both tools in evaluating fluid responsiveness. PPV remains the strongest predictor.

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