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<p>Passive leg raising (PLR) is commonly used to assess fluid responsiveness in critically ill patients. Transthoracic echocardiography is frequently used to measure stroke volume changes during PLR but requires operator expertise and adequate image acquisition. Bioreactance-based monitoring offers a noninvasive and continuous alternative; however, agreement between bioreactance-derived and echocardiography-derived assessments of fluid responsiveness remains uncertain. We conducted a prospective observational study (ClinicalTrials.gov identifier: NCT07020637) in a medical intensive care unit involving adult patients with shock requiring vasopressor support. Stroke volume was measured before and after passive leg raising using both transthoracic echocardiography and a bioreactance-based monitoring system. Fluid responsiveness was defined as an increase in stroke volume of at least 10% following passive leg raising. Correlation, Bland–Altman analysis, and responder classification agreement were performed to evaluate agreement between bioreactance-derived and echocardiography-derived assessments of fluid responsiveness. Receiver operating characteristic (ROC) curve analysis was performed as a secondary analysis using echocardiography as the reference method for responder classification. Thirty patients were enrolled. Echocardiography identified 12 patients (40.0%) as PLR responders, whereas bioreactance identified 16 patients (53.3%) as responders. Correlation between echocardiography-derived and bioreactance-derived percentage stroke volume changes was weak and non-significant (r = −0.072, <i>p </i>= 0.705). Bland–Altman analysis demonstrated a bias of −6.8% (95% CI − 18.2% to 4.6%), with wide limits of agreement (−66.5% to + 52.8%). Overall responder classification agreement was 53.3%, with a Cohen’s kappa coefficient of 0.079 (95% CI −0.264 to 0.422). ROC analysis showed poor discrimination of bioreactance-derived stroke volume changes for identifying echocardiography-defined responders (AUC 0.542, 95% CI 0.318–0.765; <i>p </i> = 0.715). Bioreactance-derived stroke volume changes during passive leg raising demonstrated poor agreement with echocardiographic assessment of fluid responsiveness in critically ill patients with shock. Correlation, classification agreement, and diagnostic performance were all limited, suggesting that bioreactance and echocardiography should not be considered interchangeable methods for assessing fluid responsiveness in this population.</p>

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Poor agreement between bioreactance and echocardiography during passive leg raising in patients with shock

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月2日

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  • Antonious Anis,
  • Juliann Shih,
  • Vidhani Goel,
  • Kavita Batra,
  • Irene Huang,
  • Mutsumi J. Kioka

摘要

Passive leg raising (PLR) is commonly used to assess fluid responsiveness in critically ill patients. Transthoracic echocardiography is frequently used to measure stroke volume changes during PLR but requires operator expertise and adequate image acquisition. Bioreactance-based monitoring offers a noninvasive and continuous alternative; however, agreement between bioreactance-derived and echocardiography-derived assessments of fluid responsiveness remains uncertain. We conducted a prospective observational study (ClinicalTrials.gov identifier: NCT07020637) in a medical intensive care unit involving adult patients with shock requiring vasopressor support. Stroke volume was measured before and after passive leg raising using both transthoracic echocardiography and a bioreactance-based monitoring system. Fluid responsiveness was defined as an increase in stroke volume of at least 10% following passive leg raising. Correlation, Bland–Altman analysis, and responder classification agreement were performed to evaluate agreement between bioreactance-derived and echocardiography-derived assessments of fluid responsiveness. Receiver operating characteristic (ROC) curve analysis was performed as a secondary analysis using echocardiography as the reference method for responder classification. Thirty patients were enrolled. Echocardiography identified 12 patients (40.0%) as PLR responders, whereas bioreactance identified 16 patients (53.3%) as responders. Correlation between echocardiography-derived and bioreactance-derived percentage stroke volume changes was weak and non-significant (r = −0.072, p = 0.705). Bland–Altman analysis demonstrated a bias of −6.8% (95% CI − 18.2% to 4.6%), with wide limits of agreement (−66.5% to + 52.8%). Overall responder classification agreement was 53.3%, with a Cohen’s kappa coefficient of 0.079 (95% CI −0.264 to 0.422). ROC analysis showed poor discrimination of bioreactance-derived stroke volume changes for identifying echocardiography-defined responders (AUC 0.542, 95% CI 0.318–0.765; p  = 0.715). Bioreactance-derived stroke volume changes during passive leg raising demonstrated poor agreement with echocardiographic assessment of fluid responsiveness in critically ill patients with shock. Correlation, classification agreement, and diagnostic performance were all limited, suggesting that bioreactance and echocardiography should not be considered interchangeable methods for assessing fluid responsiveness in this population.