Clinical Commentary

Intensive Care Medicine

, Volume 34, Issue 4, pp 659-663

Passive leg raising

  • Xavier MonnetAffiliated withService de réanimation médicale, Hôpital de Bicêtre, AP-HPEquipe d’accueil EA 4046, Faculté de Médecine Paris-Sud, Université Paris-Sud Email author 
  • , Jean-Louis TeboulAffiliated withService de réanimation médicale, Hôpital de Bicêtre, AP-HPEquipe d’accueil EA 4046, Faculté de Médecine Paris-Sud, Université Paris-Sud

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Abstract

Objective

To assess whether the passive leg raising test can help in predicting fluid responsiveness.

Design

Nonsystematic review of the literature.

Results

Passive leg raising has been used as an endogenous fluid challenge and tested for predicting the hemodynamic response to fluid in patients with acute circulatory failure. This is now easy to perform at the bedside using methods that allow a real time measurement of systolic blood flow. A passive leg raising induced increase in descending aortic blood flow of at least 10% or in echocardiographic subaortic flow of at least 12% has been shown to predict fluid responsiveness. Importantly, this prediction remains very valuable in patients with cardiac arrhythmias or spontaneous breathing activity.

Conclusions

Passive leg raising allows reliable prediction of fluid responsiveness even in patients with spontaneous breathing activity or arrhythmias. This test may come to be used increasingly at the bedside since it is easy to perform and effective, provided that its effects are assessed by a real-time measurement of cardiac output.

Keywords

Fluid responsiveness Passive leg raising Volume expansion Cardiac preload