Тест с пассивным подъемом нижних конечностей – оптимальная методика проведения. Систематический обзор и мета-анализ (обзор литературы)

Введение. Тест с пассивным подъемом нижних конечностей (PLR-тест) – один из наиболее распространенных диагностических тестов для оценки реакции на инфузионную нагрузку. Однако не существует общепринятой методики, описывающей детали его проведения.

Цель – определить критерии выполнения PLR-теста, основываясь на диагностической точности различных вариантов.

Материалы и методы. Проведен систематический обзор и метаанализ проспективных когортных исследований, изучающих диагностическую точность различных вариантов проведения PLR-теста. Первичная конечная точка – площадь под ROC-кривой (AUROC). Поиск публикаций проводился до марта 2024 г. и был дополнен методом «снежного кома». Для оценки влияния ковариат использовалась одномерная метарегрессия. Риск систематической ошибки оценивали с помощью QUADAS-2, уровень доказательств – с помощью подхода GRADE.

Результаты. В метаанализ включено 33 проспективных когортных исследования, 1607 пациентов реанимационного профиля. AUROC (PLR-тест) = 0,882 [0,849; 0,916] (средний уровень доказательств). Трансторакальная, трансэзофагеальная эхокардиография, транспульмональная термодилюция и анализ контура пульсовой волны сопоставимы как методы оценки сердечной гемодинамики при проведении PLR-теста, p = 0,253 (средний уровень доказательств). Оценка показателей сердечной гемодинамики в течение первых 2 мин от начала проведения PLR-теста увеличивает диагностическую точность (высокий уровень доказательств). Начальное положение тела (низкое положение Фаулера, горизонтальное положение на спине) при проведении PLR-теста не влияет на диагностическую точность (низкий уровень доказательств). Базовые ковариаты (возраст, пол) не влияют на диагностическую точность PLR-теста у реанимационных пациентов (высокий уровень доказательств).

Заключение. Для оценки восприимчивости реанимационных пациентов к инфузионной нагрузке рекомендуется проведение PLR-теста с оценкой изменений показателей внутрисердечной гемодинамики любым из основных методов в течение 2 мин от начала теста. Предпочтительным исходным положением тела при проведении PLR-теста является низкое положение Фаулера.

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