Key result
Passive leg raising can predict fluid responsiveness in critically ill patients on high-dose vasopressors, but the optimal cutoff for cardiac output changes remains uncertain.
Why the study?
Can passive leg raising be used to guide fluid administration?
Can passive leg raising be used to guide fluid administration?
Passive leg raising is discussed as a method to predict fluid responsiveness, particularly useful in patients with arrhythmias or spontaneous respiratory movements where dynamic indices fail.
Predicting fluid responsiveness has become a topic of major interest. Measurements of intravascular pressures and volumes often fail to predict the response to fluids, even though very low values are usually associated with a positive response to fluids. Dynamic indices reflecting respiratory-induced variations in stroke volume have been developed; however, these cannot be used in patients with arrhythmia or with spontaneous respiratory movements. The passive leg raising (PLR) test has been suggested to predict fluid responsiveness. PLR induces an abrupt increase in preload due to autotransfusion of blood contained in capacitance veins of the legs, which leads to an increase in cardiac output in preload-dependent patients. This commentary discusses some of the technical issues related to this test.
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Daniel De Backer (2006) conducted an editorial in Acute circulatory failure. Passive leg raising (PLR) was evaluated. Passive leg raising can predict fluid responsiveness in critically ill patients on high-dose vasopressors, but the optimal cutoff for cardiac output changes remains uncertain.
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