Intensive Care Medicine

, 35:85

Passive leg raising for predicting fluid responsiveness: importance of the postural change

  • Julien Jabot
  • Jean-Louis Teboul
  • Christian Richard
  • Xavier Monnet
Original

DOI: 10.1007/s00134-008-1293-3

Cite this article as:
Jabot, J., Teboul, JL., Richard, C. et al. Intensive Care Med (2009) 35: 85. doi:10.1007/s00134-008-1293-3

Abstract

Objective

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.

Design

Prospective study

Setting

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%.

Interventions

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.

Conclusions

PLRSEMIREC induces larger increase in cardiac preload than PLRSUPINE and may be preferred for predicting fluid responsiveness.

Keywords

Passive leg raising Fluid responsiveness Central venous pressure Sepsis 

Abbreviations

PLR

Passive leg raising

PLRSEMIREC

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

PLRSUPINE

Passive leg raising performed by elevating the patient’s legs from the supine position

Supplementary material

134_2008_1293_MOESM1_ESM.doc (30 kb)
ESM (DOC 29 kb)

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Julien Jabot
    • 1
    • 2
  • Jean-Louis Teboul
    • 1
    • 2
  • Christian Richard
    • 1
    • 2
  • Xavier Monnet
    • 1
    • 2
  1. 1.Service de Réanimation Médicale, AP-HP, Hôpital de BicêtreCentre Hospitalier Universitaire de BicêtreLe Kremlin-BicêtreFrance
  2. 2.Faculté de Médecine Paris-SudUniv Paris-SudLe Kremlin-BicêtreFrance