Passive leg raising for predicting fluid responsiveness: importance of the postural change
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- Jabot, J., Teboul, JL., Richard, C. et al. Intensive Care Med (2009) 35: 85. doi:10.1007/s00134-008-1293-3
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For predicting fluid responsiveness by passive leg raising (PLR), the lower limbs can be elevated at 45° either from the 45° semi-recumbent position (PLRSEMIREC) or from the supine position (PLRSUPINE). PLRSUPINE could have a lower hemodynamic impact than PLRSEMIREC since it should not recruit the splanchnic venous reservoir.
A 24-bed medical intensive care unit.
Patients and participants
A total of 35 patients with circulatory failure who responded to an initial PLRSEMIREC by an increase in cardiac index ≥ 10%.
PLRSEMIREC, a transfer from the semi-recumbent to the supine position and PLRSUPINE were performed in all patients in a random order before fluid expansion (500 mL saline).
Measurements and results
PLRSEMIREC, supine transfer and PLRSUPINE significantly increased the pulse-contour derived cardiac index (PiCCOplus) by 22 (17–28)%, 9 (5–15)% and 10 (7–14)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. These maneuvers significantly increased the right ventricular end-diastolic area (echocardiography) by 20 (14–29)%, 9 (5–16)% and 10 (5–16)% (P < 0.05 vs. PLRSEMIREC for the latter two) and the central venous pressure by 33 (22–50)%, 15 (10–20)% and 20 (15–29)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. Volume expansion significantly increased cardiac index by 27 (21–38)% and all patients were responders to volume expansion. If an increase in cardiac index ≥ 10% is considered as a positive response to PLRSUPINE, 15 (43%) patients would have been unduly predicted as non-responders to fluid administration by PLRSUPINE.
PLRSEMIREC induces larger increase in cardiac preload than PLRSUPINE and may be preferred for predicting fluid responsiveness.
KeywordsPassive leg raising Fluid responsiveness Central venous pressure Sepsis
Passive leg raising
Passive leg raising performed by elevating the patient’s legs and by simultaneously transferring the trunk from the semi-recumbent position to a horizontal position
Passive leg raising performed by elevating the patient’s legs from the supine position