Passive head-up tilt for predicting fluid responsiveness in critically ill patients
Passive head-up tilt and fluid responsiveness
DOI:
https://doi.org/10.54205/ccc.v34.279538Keywords:
Fluid responsiveness, Fluid challenge test, Passive head-up tilt, Critical care, Intensive care unitAbstract
Background: Assessment of fluid responsiveness is crucial for optimizing hemodynamic management in critically ill patients. Conventional tests such as the passive leg-raising (PLR) maneuver or fluid challenge may be limited by equipment constraints. This study evaluated the ability of the passive head-up tilt (HUT) test to predict fluid responsiveness without external fluid loading or heart–lung interaction.
Method: This prospective observational study enrolled 52 critically ill adults with shock undergoing cardiac output monitoring using pulse contour analysis. Hemodynamic parameters, including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke volume (SV), and cardiac output (CO), were recorded at baseline, during a 45° head-up tilt, and after returning to the supine position. A standard fluid challenge (250 mL crystalloid or colloid over 15 minutes) was used as the reference, and fluid responsiveness was defined as a stroke volume increase of more than 10%. Diagnostic performance was analyzed using the area under the receiver operating characteristic (AUROC) curve.
Result: Seventeen patients (32.7%) were responders. Most patients were in normal sinus rhythm (86.5%) and under positive-pressure ventilation (82.7%), with no between-group difference. The mean baseline CO was 4.8 L/min (IQR 3.75–6.4), and the mean SBP was 119.5 ± 17.6 mmHg. The change in SV from baseline to 1 minute after HUT showed the best diagnostic accuracy, with an AUROC = 0.67, sensitivity = 76%, and specificity = 57% at a 10% cutoff. Both SV and CO decreased during head elevation and increased after returning to supine, consistent with physiologic changes in venous return.
Conclusion: The passive head-up tilt test demonstrated poor to moderate accuracy for predicting fluid responsiveness. Rather than serving as a replacement for passive leg raising, HUT may be considered a supplementary or screening maneuver in situations where PLR is not feasible because of bed design or patient-related limitations.
Trial registration: TCTR20250129003
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