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August 17, 2025Open Access

Comparison of Predictive Value of End-Expiratory Occlusion Test and Passive Leg Raising in Predicting Fluid Responsiveness in Postoperative Patients

TDTrinh DongChina Agricultural University HHHai Hong HoNational Hospital of Pediatrics VKVũ Văn Khâm

Key Points

Positive fluid responsiveness identified in 24 out of 31 postoperative patients, indicating a 77.4% response rate.
End-expiratory occlusion test achieved an area under the curve of 0.898, showing high sensitivity and reasonable specificity.
Passive leg raising test showed AUC of 0.786, with high specificity but lower sensitivity than the EEO test.
Both methods demonstrated comparable predictive capacities for fluid responsiveness, emphasizing their clinical utility.

Abstract

Background: Fluid management in postoperative patients is challenging due to physiological changes, surgical stress, and comorbidities. Accurate prediction of fluid responsiveness (FR) is essential to avoid complications from under- or over-resuscitation. Objectives: The present study compared the predictive value of two non-invasive methods — the end-expiratory occlusion (EEO) test and the passive leg raising (PLR) test — in assessing FR in mechanically ventilated postoperative patients. Methods: This prospective, non-randomized, interventional study enrolled 31 mechanically ventilated critically ill postoperative patients. Hemodynamic monitoring was performed using the PiCCO system. Baseline parameters were recorded (T0), followed by a 30-second EEO test (T1). After a 5-minute recovery period (T2), a 90-second PLR test was conducted (T3). Patients subsequently received 500 mL of crystalloid solution over 30 minutes, and post-infusion hemodynamic measurements were obtained (T4). Positive FR was defined as a Cardiac Index (CI) ≥ 15% increase in CI at T4 compared to T0. Results: Among the 31 patients, 24 (77.4%) were fluid responsive. Neither EEO nor PLR significantly altered heart rate; however, both increased blood pressure (EEO: 6.7 ± 5.86 mm Hg, PLR: 8.9 ± 8.7 mm Hg) and cardiac output (EEO: 8 ± 3%, PLR: 15 ± 6%). The EEO-induced ΔCI predicted positive FR with an area under the curve (AUC) of 0.898, a sensitivity of 95.8%, a specificity of 85.7%, and a cutoff of 5.3%. The PLR-induced ΔCI yielded an AUC of 0.786, a sensitivity of 66.6%, a specificity of 100%, and a cutoff value of 13.4%. No significant difference in FR prediction was observed between the two methods (P > 0.05). Conclusions: Both EEO and PLR demonstrate high predictive value for FR in postoperative patients. Although PLR induced greater hemodynamic changes than EEO, their predictive capacities were comparable.

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