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.
| 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.
Tags: shock
