Passive leg raising test

Not to be confused with Straight leg raise.

In medicine, the passive leg raising test is a bedside test to evaluate the need for further fluid resuscitation in critically ill patients.[1]

The test involves raising the legs of a patient (without his active participation), which causes gravity to pull blood from the legs, thus increasing circulatory volume available to the heart (cardiac preload) by around 500 milliliters. The real-time effects of this manoeuvre on haemodynamic parameters such as blood pressure and heart rate are used to guide the decision whether or not more fluid will be beneficial.[2][3] The assessment is easier when invasive monitoring is present (such as an arterial catheter).

The manoeuvre might be reinforced in a clinical setting by moving the patient's bed from a semi-recumbent position to a recumbent position with the legs raised. This is theorised to cause an additional mobilisation of blood from the gastrointestinal circulation.[4][5]

Several studies showed that this measure is a better predictor of response to rapid fluid loading than other tests such as respiratory variation in pulse pressure or echocardiographic markers.[5][6][7][8]

Footnotes

  1. ^ Monnet X, Teboul JL (April 2008). "Passive leg raising". Intensive Care Med 34 (4): 659–63. doi:10.1007/s00134-008-0994-y. PMID 18214429. 
  2. ^ Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G (April 2002). "Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients". Chest 121 (4): 1245–52. doi:10.1378/chest.121.4.1245. PMID 11948060. http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=11948060. 
  3. ^ Maizel J, Airapetian N, Lorne E, Tribouilloy C, Massy Z, Slama M (July 2007). "Diagnosis of central hypovolemia by using passive leg raising". Intensive Care Med 33 (7): 1133–8. doi:10.1007/s00134-007-0642-y. PMID 17508202. 
  4. ^ Jabot J, Teboul JL, Richard C, Monnet X (September 2008). "Passive leg raising for predicting fluid responsiveness: importance of the postural change". Intensive Care Med 35 (1): 85–90. doi:10.1007/s00134-008-1293-3. PMID 18795254. 
  5. ^ a b Teboul JL, Monnet X (June 2008). "Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity". Curr Opin Crit Care 14 (3): 334–9. doi:10.1097/MCC.0b013e3282fd6e1e. PMID 18467896. 
  6. ^ Monnet X, Rienzo M, Osman D, et al. (May 2006). "Passive leg raising predicts fluid responsiveness in the critically ill". Crit. Care Med. 34 (5): 1402–7. doi:10.1097/01.CCM.0000215453.11735.06. PMID 16540963. 
  7. ^ Lamia B, Ochagavia A, Monnet X, Chemla D, Richard C, Teboul JL (July 2007). "Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity". Intensive Care Med 33 (7): 1125–32. doi:10.1007/s00134-007-0646-7. PMID 17508199. 
  8. ^ Lafanechère A, Pène F, Goulenok C, et al. (2006). "Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients". Crit Care 10 (5): R132. doi:10.1186/cc5044. PMC 1751046. PMID 16970817. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1751046. 

See also