The passive leg raising test
Introduction: The passive leg raising test (PLR) allows physicians to determine which patients require treatment with intravenous fluids.
Objectives: It is important to be aware of tools that help us to determine the response to the passive leg raising test, as well as understanding in which clinical situations it can be performed.
Materials and methods: Non-systematic review. Medline and PubMed databases were consulted in search of relevant articles.
Results: Through echocardiography, pulse pressure and capnography can be determined as a response to leg raising.
Conclusions: This article explores the tools that are useful in determining the response to this maneuver, and the clinical conditions in which it is indicated.
2. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic. Am J Respir Crit Care Med. 2000;162:134-8.
3. Upadya A, Tilluckdharry L, Muralidharan V, Amoateng-Adjepong Y, Manthous Ca. Fluid balance and weaning outcomes. Intensive Care Med. 2005;31:1643-7.
4. Malbrain MLNG, Chiumello D, Pelosi P, Bihari D, Innes R, Ranieri VM, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med. 2005;33:315-22.
5. Alsous F, Khamiees M, DeGirolamo A, Amoateng-Adjepong Y, Manthous CA. Negative fluid balance predicts survival in patients with septic shock. Chest. 2000;117:1749-54.
6. Yogendran S, Asokumar B, Cheng CD, Chung HF. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg. 1995;80:682-6.
7. Venn R, Steele A, Richardson P, Poloniecki J, Grounds M, Newman P. Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures. Br J Anaesth. 2002;88:65-71.
8. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M. Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ. 2004;329:258-63.
9. Lopes MR, Oliveira MA, Pereira VOS, Lemos IPB, Auler JOC, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Crit Care. 2007;11:R100.
10. Wakeling HG, McFall MR, Jenkins CS, Woods WGA, Miles WFA, Barclay GR, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95:634-42.
11. Chytra I, Pradl R, Bosman R, Pelnâr P, Kasal E, Zidkovâ A. Esophageal Doppler-guided fluid management decreases blood lactate levels in multiple-trauma patients: a randomized controlled trial. Crit Care. 2007;11:R24.
12. Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. Br J Anaesth. 1997;315:909-12.
13. Eduardo C, Sabogal L, Felipe A, Rivera C, Joya Y. Lactato y déficit de bases en trauma: valor pronóstico. Rev Colomb Anestesiol. 2015;2:60-4.
14. Marik PE, Baram M, Vahid B. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134:172-8.
15. Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, et al. Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32:691-9.
16. Azriel P, Pizov R, Cotev S. Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology. 1987;67:498-502.
17. Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984-9.
18. Marik PE, Cavallazi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642-7.
19. Michard F. Changes in arterial pressure during mechanical. Anesthesiology. 2005;103:34-6.
20. Jardin FOIS, Farcot J, Gueret P, Prost JF, Ozier Y, Bourdarias JP. Cyclic changes in arterial pulse during respiratory support. Circulation. 1983:266-74.
21. Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, et al. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med. 2007;33:1117-24.
22. Rutlen DL, Wackers FJ, Zaret BL. Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation. 1981;64:146-52.
23. Jabot J, Teboul J-L, Richard C, Monnet X. Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med. 2009;35:85-90.
24. Reich D, Konstadt S, Raissi S. Trendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery disease. Crit Care Med. 1989;17:313-7.
25. Boulain T, Achard J, Teboul J, 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;121:1245-52.
26. Valtier B, Cholley BP, Belot J, De Coussaye J, Mateo J, Payen DM. Noninvasive monitoring of cardiac output in critically ill patients using transesophageal Doppler. Am J Respir Crit Care Med. 1998;158:77-83.
27. Roeck M, Jakob SM. Change in stroke volume in response to fluid challenge: assessment using esophageal Doppler. Intensive Care Med. 2003;29:1729-35.
28. Lafanechère A, Pène F, Goulenok C, Delahaye A, Mallet V, Choukroun G, et al. Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients. Crit Care. 2006;10:1-8.
29. Coirault C, Zamani K, Chemla D, He J, Suard I, Colin P, et al. Total arterial compliance estimated by stroke volume-to-aortic pulse pressure ratio in humans. Am J Physiol. 1998;274:H500-5.
30. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006;34:1402-7.
31. Maizel J, Airapetian N, Lorne E, Tribouilloy C, Massy Z, Slama M. Diagnosis of central hypovolemia by using passive leg raising. Intensive Care Med. 2007;33:1133-8.
32. Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul J. Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity. Intensive Care Med. 2007;33:1125-32.
33. Préau S, Saulnier F, Dewavrin F, Durocher A, Chagnon J. Passive leg raising is predictive of fluid responsiveness in spontaneously breathing patients with severe sepsis or acute pancreatitis. Crit Care Med. 2010;38:819-25.
34. Monnet X, Chemla D, Osman D, Anguel N, Richard C, Pinsky MR, et al. Measuring aortic diameter improves accuracy of esophageal Doppler in assessing fluid responsiveness. Crit Care Med. 2007;35:477-82.
35. De Backer D, Pinsky M. Can one predict fluid responsiveness in spontaneously breathing patients? Intensive Care Med. 2007;33:1111-3.
36. Monnet X, Bataille A, Magalhaes E, Barrois J, Corre M, Le Gosset C, et al. 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.
37. Biais M, Vidil L, Sarrabay P, Cottenceau V, Revel P. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and VigileoTM/FloTracTM device. Crit Care. 2009;13:R195.
38. Gouvea G, Diaz R, Auler L, Toledo R, Martinho JM. Evaluation of the pulse pressure variation index as a predictor of fluid responsiveness during orthotopic liver transplantation. Br J Anaesth. 2009;103:238-43.
39. Matthieu B, Karine N-G, Vincent C, Alain V, Francois CJ, Philippe R, et al. Cardiac output measurement in patients undergoing liver transplantation: pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis. Anesth Analg. 2008;106:1480-6.
40. Biancofiore G, Critchley LAH, Lee A, Yang X, Bindi LM, Esposito M, et al. Evaluation of a new software version of the FloTrac/Vigileo (Version 3.02) and a comparison with previous data in cirrhotic patients undergoing liver transplant surgery. Anesth Analg. 2011;113:515-22.
41. Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer J-H. Performance of a minimally invasive uncalibrated cardiac output monitoring system (FlotracTM/VigileoTM) in haemodynamically unstable patients. Br J Anaesth. 2008;100:451-6.
42. Buhre W, Weyland A, Buhre K, Kazmaier S, Mursch K, Schmidt M, et al. Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth. 2000;84:354-7.
43. Cavallaro F, Sandroni C, Marano C, La Torre G, Mannocci A, De Waure C, et al. 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;36:1475-83.
44. Gan H, Cannesson M, Chandler JR, Ansermino JM. Predicting fluid responsiveness in children. Anesth Analg. 2013;117:1380-92.
45. Vivier E, Metton O, Piriou V, Lhuillier F, Branche P, Duperret1 S, et al. Effects of increased intra-abdominal pressure on central circulation. Intensive Care Med. 2006;96:701-7.
46. Renner J, Gruenewald M, Quaden R, Hanss R, Meybohm P, Steinfath M, et al. Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model. Crit Care Med. 2009;37:650-8.
47. Jacques D, Bendjelid K, Duperret S, Colling J, Piriou V, Viale J. Pulse pressure variation and stroke volume variation during increased intra-abdominal pressure: an experimental study. Crit Care 2011;15:R33.
48. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I: Definitions. Intensive Care Med. 2006;32:1722-32.
49. Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, DeWaele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II: Recommendations. Intensive Care Med. 2007;33:951-62.
50. Mahjoub Y, Touzeau J, Airapetian N, Lorne E, Hijazi U, Zogheib E, et al. The passive leg-raising maneuver cannot accurately predict fluid responsiveness in patients with intra-abdominal hypertension. Crit Care Med. 2010;38:1824-9.
51. Monnet X, Bleibtreu A, Dres M, Gharbi R, Richard C, Teboul J. Passive leg-raising and end-expiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance. Crit Care Med. 2012;40:152-7.
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