Pneumatic leg compression-induced changes in cardiac output predict fluid responsiveness in traumatic brain injury and post-operative neurosurgery with septic shock

To assess whether hemodynamic changes induced by pneumatic leg compression (PLC) can predict fluid responsiveness in patients with traumatic brain injury and post-operative neurosurgical patients with septic shock. Patients were categorized into two groups based on their response to a 500 mL crystalloid fluid bolus: the fluid responder group (increase in stroke volume [SV] >10% from baseline) and the fluid non-responder group (increase in SV ≤10%). Hemodynamic variables cardiac output (CO) and SV were measured using esophageal Doppler at four time points: (1) pre-PLC, (2) post-PLC, (3) pre-fluid bolus, and (4) post-fluid bolus. Percent changes in SV and CO following PLC were compared between groups. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis. Following PLC, the fluid responder group demonstrated significantly greater increases in both SV and CO compared to the non-responder group. A post-PLC SV change ≥3.5% predicted fluid responsiveness with a sensitivity of 88.2% and specificity of 87.5% (AUC = 0.90, p = 0.01). In contrast, a post-PLC CO change ≥5.4% had a sensitivity of 64.7% and specificity of 87.5% (AUC = 0.787, p = 0.03). PLC-induced changes in SV, and to a lesser extent CO, are promising dynamic parameters for predicting fluid responsiveness in postoperative neurosurgical patients requiring neurocritical care and presenting with septic shock. This approach may offer a safe, non-invasive alternative to traditional fluid challenges, particularly in patient sample at risk for intracranial hypertension.