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Bedside assessment of passive leg raising effects on venous return

Journal of Clinical Monitoring and Computing volume 25, Article number: 257 (2011) Cite this article

Abstract

Objective

Passive leg raising (PLR) provides a reversible fluid-loading challenge and can be used to predict fluid responsiveness. The amount of blood volume recruited by this maneuver called stressed volume (Vs) is unknown. The present study aims to assess the quantitative effects of passive leg raising on venous return at bedside.

Methods

We conducted a prospective interventional study. Nine mechanically ventilated postoperative cardiac surgery patients with preserved left ventricular function were enrolled. Cardiac output (CO) was continuously monitored by PiCCO™ via the pulse contour method. Ten second intervals of inspiratory breath holding at four plateau pressures (5, 15, 25 and 35 cm H2O) were performed to measure the relationship between blood flow (CO) and central venous pressure (CVP). These were used to determine mean systemic filling pressure (Pmsf) and Vs. Patients were studied at three successive steps: semirecumbent position, after PLR and back in the semirecumbent position after volume expansion (VE).

Results

Similar to VE, PLR significantly increased Pmsf from 19.7 (17.0–22.6) mmHg at baseline to 22.0 (18.5–27.8) mmHg (p <0.05). CO increased 11.1% (9.5–20) with PLR and 14.8% (4.2–19.9) with VE. Venous return resistance was unchanged throughout the three conditions, whereas the the pressure gradient for venous return (Pmsf-CVP) increased during PLR (p = 0.058) and during VE (p < 0.05). Baseline circulatory compliance was 1.14 (0.52–2.65) ml mm Hg−1 kg−1. Vs increased to 3.5 (1.1–3.9) ml kg−1 with PLR.

Conclusions

The effect of transient hemodynamic changes on venous return induced by passive leg raising can be directly measured in intensive care patients using inspiratory-hold procedures. This technique makes quantification of PLR feasible and could be used clinically to assess fluid responsiveness.

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Abbreviations

PLR:

Passive leg raising

CO:

Cardiac output

Pmsf:

Mean systemic filling pressure

Pvr:

Venous return pressure

VR:

Venous return

Vs:

Stressed volume

CVP:

Central venous pressure

Pplat:

Plateau pressure

Rsys:

Total systemic resistance

MAP:

Mean arterial pressure

Rvr:

Resistance to venous return

Csys:

Systemic compliance

VE:

Volume expansion

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Affiliations

  1. Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital and Claude Bernard Lyon 1 University, Lyon, France

    Geoffray Keller MD, Marlène Benard MD & Jean-Jacques Lehot MD, PhD

  2. Hospices Civils de Lyon, Groupement Hospitalier Est, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Lyon, France

    Olivier Desebbe MD & Jean-Baptiste Bouchet MD

  3. Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 avenue du Doyen Lépine, 69500, Bron, France

    Geoffray Keller MD

Authors
  1. Geoffray Keller MD
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  2. Olivier Desebbe MD
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  3. Marlène Benard MD
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  4. Jean-Baptiste Bouchet MD
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  5. Jean-Jacques Lehot MD, PhD
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Correspondence to Geoffray Keller MD.

Additional information

Keller G, Desebbe O, Benard M, Bouchet J-B, Lehot J-J. Bedside assessment of passive leg raising effects on venous return.

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Keller, G., Desebbe, O., Benard, M. et al. Bedside assessment of passive leg raising effects on venous return. J Clin Monit Comput 25, 257 (2011). https://doi.org/10.1007/s10877-011-9303-3

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  • DOI: https://doi.org/10.1007/s10877-011-9303-3

Keywords

  • passive leg raising
  • mean systemic filling pressure
  • circulatory compliance
  • stressed volume
  • cardiac surgery