Passive leg raising: Simple and reliable technique to prevent fluid overload in critically ill patients

Abstract

Background:Dynamic measures, the response to stroke volume (SV) to fluid loading, have been used successfully to guide fluid management decisions in critically ill patients. However, application of dynamic measures is often inaccurate to predict fluid responsiveness in patients with arrhythmias, ventricular dysfunction or spontaneously breathing critically ill patients. Passive leg raising (PLR) is a simple bedside maneuver that may provide an accurate alternative to guide fluid resuscitation in hypovolemic critically ill patients.Methods:Pertinent medical literature for fluid responsiveness in the critically ill patient published in English was searched over the past three decades, and then the search was extended as linked citations indicated.Results:Thirty-three studies including observational studies, randomized control trials, systemic review, and meta-analysis studies evaluating fluid responsiveness in the critically ill patient met selection criteria.Conclusions:PLR coupled with real-time SV monitors is considered a simple, noninvasive, and accurate method to determine fluid responsiveness in critically ill patients with high sensitivity and specificity for a 10% increase in SV. The adverse effect of albumin on the mortality of head trauma patients and chloride-rich crystalloids on mortality and kidney function needs to be considered when choosing the type of fluid for resuscitation.

Accuracy of Passive Leg Raising Test in Prediction of Fluid Responsiveness in Children

“…According to previous studies, fluid responsiveness was considered positive when delta SV was more than 10% after fluid challenge. 1 , 17 …”

“…Moreover, all patients admitted to pediatric intensive care units (PICUs) would receive intravenous fluid for one reason or another. 1 Fluid replacement is often necessary to optimize the cardiovascular function by maintaining adequate cardiac preload and output providing enough tissue oxygen delivery, which is essential in the management of critically ill patients. 2 Optimal fluid management is crucial to avoid the deleterious effect of over, under, or inappropriate resuscitation.…”

“…The effects of PLR must be evaluated with a real-time measurement of CO. 7 , 10 , 12 The smaller lower body size in children makes this reservoir less functioning as compared to adults. 1 , 9 Thus, PLR evaluation in children is more challenging. The rationale of the current study was to assess the ability of PLR to anticipate fluid responsiveness in critically ill, under age of 5 years, when compared with the standard fluid challenge.…”

Fluid management: An update for perioperative practitioners

“…Examination of hypovolaemic patients should include assessment of skin turgor, mucus membranes and cardiovascular response following passive straight leg raise. Passive straight leg raise is a non-invasive technique used to determine fluid responsiveness whereby elevation of a patient’s leg improves venous return and thus blood pressure (Assadi 2017). After performing this test, a 20% increase in systolic blood pressure advocates ongoing fluid replacement.…”

Assessing the Utility of End-Tidal Carbon Dioxide as a Marker for Fluid Responsiveness in Cardiogenic Shock

“…Mean age was 61.3 ± 14.8 years and 40%(24) were females. About 53.3% (32) were known diabetics, 45%(27) were hypertensive, and 28.3%(17) had chronic obstructive pulmonary disease (COPD). Mean acute physiology and chronic health evaluation (APACHE) II score was 14.82 ± 7.49; 21 (35%) patients were on an intra-aortic balloon pump.…”