Passive leg raising: keep it easy!

Monnet, Xavier; Teboul, Jean‐Louis

doi:10.1007/s00134-010-1900-y

Cited by 12 publications

(4 citation statements)

References 5 publications

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“…Starting the PLR maneuver from a total horizontal position may induce an insufficient venous blood shift to elevate significantly cardiac preload [52]. By contrast, starting PLR from a semirecumbent position induces a larger increase in cardiac preload because it induces the shift of venous blood not only from both the legs but also from the abdominal compartment [53]. In should be noted that intra-abdominal hypertension (intra-abdominal pressure > 16 mmHg) impairs venous return and reduces the ability of PLR to detect fluid responsiveness [54].…”

Section: Passive Leg Raisingmentioning

confidence: 99%

Hemodynamic parameters to guide fluid therapy

Marik

Monnet

Teboul

2011

Ann. Intensive Care

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555

266

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The clinical determination of the intravascular volume can be extremely difficult in critically ill and injured patients as well as those undergoing major surgery. This is problematic because fluid loading is considered the first step in the resuscitation of hemodynamically unstable patients. Yet, multiple studies have demonstrated that only approximately 50% of hemodynamically unstable patients in the intensive care unit and operating room respond to a fluid challenge. Whereas under-resuscitation results in inadequate organ perfusion, accumulating data suggest that over-resuscitation increases the morbidity and mortality of critically ill patients. Cardiac filling pressures, including the central venous pressure and pulmonary artery occlusion pressure, have been traditionally used to guide fluid management. However, studies performed during the past 30 years have demonstrated that cardiac filling pressures are unable to predict fluid responsiveness. During the past decade, a number of dynamic tests of volume responsiveness have been reported. These tests dynamically monitor the change in stroke volume after a maneuver that increases or decreases venous return (preload) and challenges the patients' Frank-Starling curve. These dynamic tests use the change in stroke volume during mechanical ventilation or after a passive leg raising maneuver to assess fluid responsiveness. The stroke volume is measured continuously and in real-time by minimally invasive or noninvasive technologies, including Doppler methods, pulse contour analysis, and bioreactance.

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Section: Passive Leg Raisingmentioning

confidence: 99%

Hemodynamic parameters to guide fluid therapy

Marik

Monnet

Teboul

2011

Ann. Intensive Care

Self Cite

555

266

View full text Add to dashboard Cite

show abstract

“…This maneuver has been demonstrated to predict fluid responsiveness in many studies over a wide population, including clinical situations in which other parameters of fluid responsiveness have failed, such as patients with cardiac arrhythmias or with spontaneous breathing [1-3]. However, since the hemodynamic effects of PLR are usually sudden and transient, a fast-response continuous CO monitor is required to detect these changes and to characterize fluid responder patients accurately [4-6]. In this regard, several monitoring techniques have been proposed for this purpose: echocardiography [2,3,7], arterial pulse contour analysis [8,9], bioreactance [10], esophageal Doppler [1,11,12], and so on.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive assessment of fluid responsiveness by changes in partial end-tidal CO2 pressure during a passive leg-raising maneuver

et al. 2012

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BackgroundThe passive leg-raising (PLR) maneuver provides a dynamic assessment of fluid responsiveness inducing a reversible increase in cardiac preload. Since its effects are sudden and transitory, a continuous cardiac output (CO) monitoring is required to appropriately assess the hemodynamic response of PLR. On the other hand, changes in partial end-tidal CO2 pressure (PETCO2) have been demonstrated to be tightly correlated with changes in CO during constant ventilation and stable tissue CO2 production (VCO2). In this study we tested the hypothesis that, assuming a constant VCO2 and under fixed ventilation, PETCO2 can track changes in CO induced by PLR and can be used to predict fluid responsiveness.MethodsThirty-seven mechanically ventilated patients with acute circulatory failure were monitored with the CardioQ-ODM esophageal Doppler. A 2-minutes PLR maneuver was performed. Fluid responsiveness was defined according to CO increase (responders ≥ 15%) after volume expansion.ResultsPLR-induced increases in CO and PETCO2 were strongly correlated (R2 = 0.79; P < 0.0001). The areas under the receiver-operating characteristics (ROC) curve for a PLR-induced increase in CO and PETCO2 (0.97 ± 0.03 SE; CI 95%: 0.85 to 0.99 and 0.94 ± 0.04 SE; CI 95%: 0.82 to 0.99; respectively) were not significantly different. An increase ≥ 5% in PETCO2 or ≥ 12% in CO during PLR predicted fluid responsiveness with a sensitivity of 90.5% (95% CI: 69.9 to 98.8%) and 95.2% (95% CI: 76.2 to 99.9%), respectively, and a specificity of 93.7% (95% CI: 69.8 to 99.8%).ConclusionInduced changes in PETCO2 during a PLR maneuver could be used to track changes in CO for prediction of fluid responsiveness in mechanically ventilated patients with acute circulatory failure, under fixed minute ventilation and assuming a constant tissue CO2 production.

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“…It is well‐known that CO immediately after change of position increases and subsequently decreases. This has led to the recommendation that only fast reacting CO measurement methods should be employed (Monnet & Teboul, 2008, 2010), even finding its way into a renowned textbook by Marik (2015). One of the first studies was performed by Gaffney et al (1982) who studied the time course of changes in SV/CO in healthy volunteers following PLR.…”

Section: Discussionmentioning

confidence: 99%