Key result
Midazolam sedation significantly blunted the cardiac output response to the passive leg raising test (6.40 L/min vs 8.37 L/min pre-sedation), rendering the test insufficient for diagnosing fluid responsiveness in hypovolemic patients with sepsis.
Why the study?
This study used echocardiography parameters to investigate the effects of midazolam sedation on intravascular volume in intubated patients diagnosed with sepsis and treated with invasive mechanical ventilation in continuous positive airway pressure mode.
Does midazolam sedation alter the hemodynamic response to the passive leg raising test in critically ill patients with sepsis and hypovolemia?
Observational (n=152)
Double-blind
No
Does midazolam sedation alter the hemodynamic response to the passive leg raising test in critically ill patients with sepsis and hypovolemia?
Absolute Event Rate: 6.4% vs 8.37%
p-value: p=0.001
Midazolam sedation blunts the hemodynamic response to the passive leg raising test, suggesting that fluid responsiveness should be assessed prior to administering midazolam in critically ill patients.
Echocardiographic observations on midazolam in ventilated sepsis patients are hypothesis-generating; leaves open any volume effects or sedation guidance.
Background This study used echocardiography parameters to investigate the effects of midazolam sedation on intravascular volume in intubated patients who are diagnosed with sepsis and treated with invasive mechanical ventilation in continuous positive airway pressure mode. Methods This study included 152 intensive care unit patients aged 30–50 years with spontaneous breathing; all were intubated, had their lungs ventilated with a positive end-expiratory pressure of 5 cmH2O in continuous positive airway pressure mode via invasive mechanical ventilation, had a Ramsey sedation scale score of 5–6 at 5 min after midazolam administration, and exhibited a fluid deficit (i.e., inferior vena cava collapsibility index > 42% and > 12% systolic arterial pressure increase in the passive leg raising test). Cardiac index, cardiac output, and velocity time integral measurements were taken after the passive leg raising test, before and after midazolam sedation, in patients with hypovolaemia who responded to fluid treatment. Changes in passive leg raising test results were compared before and after administration of midazolam. Results Cardiac output > 15%, cardiac index > 10%, and > 15% increase in velocity time integral during the passive leg raising test before midazolam administration indicated that patients exhibited hypovolaemia and responded to fluid therapy. Cardiac output < 15%, cardiac index < 10%, and < 15% increase in velocity time integral during the passive leg raising test after midazolam administration indicated that patients did not exhibit hypovolaemia. Conclusions We recommend that the passive leg raising test, which is used to determine intravascular volume status of critically ill intensive care unit patients who exhibit hypovolaemia and respond to fluid therapy, should be performed before midazolam sedation.
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Abdülkadir Yektaş (2020) conducted an observational in Sepsis with hypovolemia and fluid responsiveness (n=152). Midazolam vs. Pre-midazolam baseline was evaluated on Cardiac output (CO) after passive leg raising test (PLRT) (p=0.001). Midazolam sedation significantly blunted the cardiac output response to the passive leg raising test (6.40 L/min vs 8.37 L/min pre-sedation), rendering the test insufficient for diagnosing fluid responsiveness in hypovolemic patients with sepsis.
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