Evaluation of Perfusion Index Change Post Passive Leg Raising for Fluid Responsiveness in Critically Ill

After approval by NHTMRI-IRB Ethical Committee.All demographic data will be obtained including the patients age, sex,associated co-morbidities (diabetes mellitus & hypertension).

Continuous blood pressure, continuous electrocardiogram, heart rate (HR), and SpO2 (measured by pulse oximetry).

Patients who are eligible and have signs of hemodynamic instability, PLR will be performed by adjusting the bed and not by manually raising the patient's legs. Bronchial secretions must be carefully aspirated before PLR. If awake, the patient should be informed of what the test involves.PLR should start from the semi-recumbent and not the supine position. Adding trunk lowering tosupine position and leg raisingfor 45° for 60 seconds, this mobilizes venous blood from the large splanchnic compartment, thus magnifying the increasing effects of leg elevation on cardiac preload.18COand PI measurements will be recorded in the same patients.

Inclusion criteria

• The subjects are adults aged ≥18 years old
• admitted tothe intensive care unit of the National Hepatologyand Tropical Medicine Research Institute (NHTMRI).
• Patients with clinical signs of hemodynamic instability i.e. a systolic blood pressure < 90 mmHg or decrease in systolic blood pressure > 40 mmHg, signs of organ hypoperfusion as oliguria < 0.5ml/Kg/hour.

Exclusion criteria

• If there is known peripheral vascular disease
• or ≥ 2 vasopressors with the maximum doses
• or in the presence of nail polish as readings from pulse oximeter will be distortedin these cases
• or if there is contraindication for PLR as uncontrolled hemodynamic status
• intracranial hypertension
• severe chronic obstructive pulmonary disease
• broncho-alveolar fistula
• severe emphysema
• and those with pre-existing comorbidities including severe left and right ventricular dysfunction, severe pulmonary hypertension
• severe obesity (BMI >40 kg/m2)
• pregnancy.