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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Editorial

Passive leg raising: five rules, not a drop of fluid!

Authors: Xavier Monnet, Jean-Louis Teboul

Published in: Critical Care | Issue 1/2015

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Excerpt

In acute circulatory failure, passive leg raising (PLR) is a test that predicts whether cardiac output will increase with volume expansion [1]. By transferring a volume of around 300 mL of venous blood [2] from the lower body toward the right heart, PLR mimics a fluid challenge. However, no fluid is infused and the hemodynamic effects are rapidly reversible [1,3], thereby avoiding the risks of fluid overload. This test has the advantage of remaining reliable in conditions in which indices of fluid responsiveness that are based on the respiratory variations of stroke volume cannot be used [1], like spontaneous breathing, arrhythmias, low tidal volume ventilation, and low lung compliance. …
Literature
1.
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL: Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006, 34:1402–1407.CrossRef
2.
Jabot J, Teboul JL, Richard C, Monnet X: Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med 2009, 35:85–90.CrossRef
3.
Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G: Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 2002, 121:1245–1252.CrossRef
4.
Lakhal K, Ehrmann S, Runge I, Benzekri-Lefevre D, Legras A, Dequin PF, Mercier E, Wolff M, Regnier B, Boulain T: Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness. Intensive Care Med 2010, 36:940–948.CrossRef
5.
Monnet X, Bataille A, Magalhaes E, Barrois J, Le Corre M, Gosset C, Guerin L, Richard C, Teboul JL: End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test. Intensive Care Med 2013, 39:93–100.CrossRef
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Bubenek-Turconi SI, Craciun M, Miclea I, Perel A: Noninvasive continuous cardiac output by the Nexfin before and after preload-modifying maneuvers: a comparison with intermittent thermodilution cardiac output. Anesth Analg 2013, 117:366–372.CrossRef
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Marik PE, Levitov A, Young A, Andrews L: The use of bioreactance and carotid Doppler to determine volume responsiveness and blood flow redistribution following passive leg raising in hemodynamically unstable patients. Chest 2013, 143:364–370.CrossRef
8.
Kupersztych-Hagege E, Teboul JL, Artigas A, Talbot A, Sabatier C, Richard C, Monnet X: Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth 2013, 111:961–966.CrossRef
9.
Mahjoub Y, Touzeau J, Airapetian N, Lorne E, Hijazi M, Zogheib E, Tinturier F, Slama M, Dupont H: The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med 2010, 38:1824–1829.CrossRef
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Malbrain ML, Reuter DA: Assessing fluid responsiveness with the passive leg raising maneuver in patients with increased intra-abdominal pressure: be aware that not all blood returns! Crit Care Med 2010, 38:1912–1915.CrossRef
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Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, Bello G, Maviglia R, Antonelli M: Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Intensive Care Med 2010, 36:1475–1483.CrossRef
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Vincent JL, Weil MH: Fluid challenge revisited. Crit Care Med 2006, 34:1333–1337.CrossRef
Metadata
Title
Passive leg raising: five rules, not a drop of fluid!
Authors
Xavier Monnet
Jean-Louis Teboul
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-014-0708-5

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