Intensive Care Medicine

, Volume 33, Issue 7, pp 1133–1138 | Cite as

Diagnosis of central hypovolemia by using passive leg raising

  • Julien Maizel
  • Norair Airapetian
  • Emmanuel Lorne
  • Christophe Tribouilloy
  • Ziad Massy
  • Michel Slama



Suspected central hypovolemia is a frequent clinical situation in hospitalized patients, and no simple bedside diagnostic test in spontaneously breathing patients is available. We tested the value of passive leg raising to predict hemodynamic improvement after fluid expansion in patients with suspected central hypovolemia.

Design and setting

Prospective study in four intensive care units at the Amiens university hospital. Thirty-four spontaneously breathing patients with suspected hypovolemia were included and were classified as responders (cardiac output increased by 12% or more after fluid expansion) or nonresponders. Patients were analyzed in the supine position during 30° leg raising and after fluid expansion.

Measurements and results

Stroke volume and cardiac output determined by echocardiographic and Doppler techniques and heart rate and blood pressure were measured at baseline, during passive leg raising and after fluid expansion. An increase of cardiac output or stroke volume by 12% or more during passive leg raising was highly predictive of central hypovolemia (AUC 0.89 ± 0.06, 95% CI 0.73–0.97 for cardiac output and AUC 0.9 ± 0.06, 95% CI 0.74–0.97 for stroke volume). Sensitivity and specificity values were 63% and 89% for cardiac output and 69%, 89% for stroke volume respectively. A close correlation (r = 0.75; p < 0.0001) was observed between cardiac output changes during leg raising and changes in cardiac output after fluid expansion.


Bedside measurement of cardiac output or stroke volume by Doppler techniques during passive leg raising was predictive of a positive hemodynamic effect of fluid expansion in spontaneously breathing patients with suspected central hypovolemia.


Cardiac Output Stroke Volume Fluid Infusion Aortic Annulus Fluid Challenge 



Grants from PHRC (Programme Hospitalier de Recherche Clinique) were obtained to conduct this clinical study.


  1. 1.
    McGee S, Abernethy WB 3rd, Simel DL (1999) The rational clinical examination. Is this patient hypovolemic? JAMA 281:1022–1029CrossRefPubMedGoogle Scholar
  2. 2.
    Mange K, Matsuura D, Cizman B, Soto H, Ziyadeh FN, Goldfarb S, Neilson EG (1997) Language guiding therapy: the case of dehydration versus volume depletion. Ann Intern 127:848–853CrossRefGoogle Scholar
  3. 3.
    Michard F, Chemla D, Richard C, Wysocki M, Pinsky MR, Lecarpentier Y, Teboul JL (1999) Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med 159:935–939CrossRefPubMedGoogle Scholar
  4. 4.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138CrossRefPubMedGoogle Scholar
  5. 5.
    Slama M, Masson H, Teboul JL, Arnould ML, Nait-Kaoudjt R, Colas B, Peltier M, Tribouilloy C, Susic D, Frohlich E, Andrejak M (2004) Monitoring of respiratory variations of aortic blood flow velocity using esophageal Doppler. Intensive Care Med 30:1182–1187CrossRefPubMedGoogle Scholar
  6. 6.
    Slama M, Masson H, Teboul JL, Arnout ML, Susic D, Frohlich E, Andrejak M (2002) Respiratory variations of aortic VTI: a new index of hypovolemia and fluid responsiveness. Am J Physiol Heart Circ Physiol 283:H1729–H1733CrossRefPubMedGoogle Scholar
  7. 7.
    Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G (2002) Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 121:1245–1252CrossRefPubMedGoogle Scholar
  8. 8.
    Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407CrossRefPubMedGoogle Scholar
  9. 9.
    Lafanechere A, Pene F, Goulenok C, Delahaye A, Mallet V, Choukroun G, Chiche J, Mira J, Cariou A (2006) Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients. Crit Care 10:R132CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Slama MA, Novara A, Van de Putte P, Diebold B, Safavian A, Safar M, Ossart M, Fagon JY (1996) Diagnostic and therapeutic implications of transesophageal echocardiography in medical ICU patients with unexplained shock, hypoxemia, or suspected endocarditis. Intensive Care Med 22:916–922CrossRefPubMedGoogle Scholar
  11. 11.
    Dittmann H, Voelker W, Karsch KR, Seipel L (1987) Influence of sampling site and flow area on cardiac output measurements by Doppler echocardiography. J Am Coll Cardiol 10:818–823CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Julien Maizel
    • 1
    • 2
  • Norair Airapetian
    • 1
  • Emmanuel Lorne
    • 2
  • Christophe Tribouilloy
    • 2
  • Ziad Massy
    • 2
  • Michel Slama
    • 1
    • 2
  1. 1.Unite de Reanimation Medicale, Service de NephrologieCHU SudAmiensFrance
  2. 2.INSERMERI 12AmiensFrance

Personalised recommendations