Case Study - Adult - Passive Leg Raise
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Where possible a Passive Leg Raise (PLR) is a safe method to determine how fluid responsive a patient might be and therefore how safe it is too increase fluids.
![Possible passive leg raising
false negative tests
Conditions of high intra-abdominal pressure
…should be noted that intra-abdominal hypertension (intra-abdominal pressure > 16
mm Hg) impairs venous return and reduces the ability of PLR to detect fluid
responsiveness [54]...
Marik et al. Annals of Intensive Care 2011, 1:1
States of severe dehydration
…the blood volume mobilized by leg raising is dependent on total blood volume and so
could be small in severely hypovolemic patients [39]…
Pinsky et al. Critical Care 2005, 9:566-572
Untimely measure of SV
…Because the maximal hemodynamic effects of PLR occur within the first minute of leg
elevation [43], it is important to assess these effects with a method that is able to track
changes in cardiac output or stroke volume on a real-time basis.
Marik et al. Annals of Intensive Care 2011, 1:1
Maneuver technique
…Jabot et al. [16] found significant differences in hemodynamic response to PLR
performed by starting from supine versus semi recumbent position but in our analysis the
reliability of PLR-cCO was proven to be independent from how the PLR maneuver was
performed….
Cavallaro F et a. Intensive Care Med (2010) 36:1475–1483
www.uscom.com.au The Measure of Life](https://image.slidesharecdn.com/casestudyadultpassivelegraise-120528195518-phpapp02/85/Case-Study-Adult-Passive-Leg-Raise-3-320.jpg)
Case Study - Adult - Passive Leg Raise
- 1. Passive Leg Raise to test for fluid response www.uscom.com.au The Measure of Life
- 2. Post Passive Leg Raise 19% increase www.uscom.com.au The Measure of Life
- 3. Possible passive leg raising false negative tests Conditions of high intra-abdominal pressure …should be noted that intra-abdominal hypertension (intra-abdominal pressure > 16 mm Hg) impairs venous return and reduces the ability of PLR to detect fluid responsiveness [54]... Marik et al. Annals of Intensive Care 2011, 1:1 States of severe dehydration …the blood volume mobilized by leg raising is dependent on total blood volume and so could be small in severely hypovolemic patients [39]… Pinsky et al. Critical Care 2005, 9:566-572 Untimely measure of SV …Because the maximal hemodynamic effects of PLR occur within the first minute of leg elevation [43], it is important to assess these effects with a method that is able to track changes in cardiac output or stroke volume on a real-time basis. Marik et al. Annals of Intensive Care 2011, 1:1 Maneuver technique …Jabot et al. [16] found significant differences in hemodynamic response to PLR performed by starting from supine versus semi recumbent position but in our analysis the reliability of PLR-cCO was proven to be independent from how the PLR maneuver was performed…. Cavallaro F et a. Intensive Care Med (2010) 36:1475–1483 www.uscom.com.au The Measure of Life
Editor's Notes
- #2: Where possible a Passive Leg Raise (PLR) is a safe method to determine how fluid responsive a patient might be and therefore how safe it is too increase fluids.Low SV - 79Low SVI – 36 (Typical 35-65)SVR - 1787 = consistent with hypovolemiaSVRI - 3931HR - > 60Low – Normal Vpk - 1.1Low CO - 4.8Low CI - 2.2 = Hypovolemia
- #3: SV 79->94 = 19% increaseNormal SV 94Normal SVI – 44Normal SVR 1196HR > 60Normal Vpk 1.3Normal CO 7.1Normal CI 3.3
- #4: When PLR test with USCOM is positive it has a 91% Positive predictive value.Although when negative, there is a high False negative rate.Causes of False negative are shown here.Therefore when PLR is negative, confirm with other input such as SVI, SVV if ventilated.