What is the normal haemodynamic response to passive leg raise? A study of healthy volunteers

Elwan, Mohammed H; Roshdy, Ashraf; Reynolds, Joseph; Elsharkawy, Eman; Eltahan, Salah; Coats, Timothy J

doi:10.1136/emermed-2017-206836

Cited by 11 publications

(22 citation statements)

References 26 publications

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“…While PLR had limited diagnostic performance in predicting FR, none of the standard monitoring parameters showed better performance. Notably, Baseline SV and CO showed a higher predictive ability than any of the currently used parameters (such as pulse rate and blood pressure), which is consistent with our volunteer results [ 16 ]. This generates an interesting hypothesis of whether baseline SV (without the PLR) could add value to the assessment of volume status in ED.…”

Section: Discussionsupporting

confidence: 90%

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Can passive leg raise predict the response to fluid resuscitation in ED?

et al. 2022

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Objective Passive leg raise (PLR) can be used as a reversible preload challenge to stratify patients according to preload response. We aim to evaluate the accuracy of PLR, monitored by a non-invasive cardiac output monitor in predicting to response to fluid resuscitation in emergency department (ED). Methods We recruited adult patients planned to receive a resuscitation fluid bolus. Patients were monitored using a thoracic electrical bioimpedance (TEB) cardiac output monitor (Niccomo, Medis, Germany). A 3-min PLR was carried out before and after fluid infusion. Stroke volume changes (ΔSV) were calculated and a positive response was defined as ≥ 15% increase. Results We recruited 39 patients, of which 37 were included into the analysis. The median age was 63 (50–77) years and 19 patients were females. 17 patients (46%) were fluid responders compared to 11 (30%) with positive response to PLR1. ΔSV with PLR1 and fluid bolus showed moderate correlation (r = 0.47, 95% confidence interval, CI 0.17–0.69) and 62% concordance rate. For the prediction of the response to a fluid bolus the PLR test had a sensitivity of 41% (95% CI 22–64) and specificity of 80% (95% CI 58–92) with an area under the curve of 0.59 (95% CI 0.41–0.78). None of the standard parameters showed a better predictive ability compared to PLR. Conclusion Using TEB, ΔSV with PLR showed a moderate correlation with fluid bolus, with a limited accuracy to predict fluid responsiveness. The PLR test was a better predictor of fluid responsiveness than the parameters commonly used in emergency care (such as heart rate and blood pressure). These data suggest the potential for a clinical trial in sepsis comparing TEB monitored, PLR directed fluid management with standard care.

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Section: Discussionsupporting

confidence: 90%

“…Undertaking PLR in awake patients may also be associated with neural responses (e.g. vagal stimulation) which may influence the ΔSV [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Can passive leg raise predict the response to fluid resuscitation in ED?

et al. 2022

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“…Passive leg raising or also known as modified Trendelenburg position is a simple method to predict patients' hemodynamic improvement after fluid resuscitation (Elwan et al, 2018;. In spontaneously breathing patients, this maneuver can be performed in patients presenting with severely low blood pressure, shock or clinical signs of dehydration.…”

Section: Discussionmentioning

confidence: 99%

The Role of Passive legs Raising Position in Hypovolemic Shock: A Case Report and Review of the Literature

et al. 2021

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Background: Hypovolemic shock can be catastrophic rapidly unless recognized and treated promptly. Although gastrointestinal loses might be the cause of hypovolemic shock in the elderly, it rarely causes a change in the blood gas analysis results.Purpose: This study aimed to report a case of a 75-year-old male with signs of hypovolemic shock caused by gastrointestinal loses and discuss the effect of passive leg raising procedure as an early nursing intervention in patients presenting with shock.Methods: The method used in this paper is a case study. The subject in this study is a 75-year-old male presenting to our Emergency Room with signs of shock which was caused by gastrointestinal problems. Passive leg raising or also known as modified Trendelenburg Position was performed as the patient presenting with low blood pressure. The results of physical dan laboratory investigation, as well as the nursing and medical therapies were presented, analyzed and discussed based on the recent literature.Results: There was an increase in the Mean Arterial Pressure (MAP) after the intervention was given for five minutes followed by fluid resuscitation with 1000 ml of warm Normal Saline. The patient responded well to the intervention given in the ED and was sent to the Intermediate Ward for further treatments.Conclusion: Passive leg raising might be beneficial to be performed in patients with hypovolemic shock as it increases the venous blood return the heart.

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“…Thus, altering filling rate to assess viscoelasticity is impractical. Lifting patients' feet to transiently increase venous return is one way to accelerate LV filling (Elwan et al, 2018) and could enable an estimate of in vivo viscoelasticity. While crude, this type of procedure can provide insight into the rate-dependent mechanical response, and may provide useful information about a patient's exercise capacity and the severity of their underlying disease.…”

Section: In Vivo Assessment Of Viscoelasticitymentioning

confidence: 99%

Need for Speed: The Importance of Physiological Strain Rates in Determining Myocardial Stiffness

Caporizzo

Prosser

2021

Front. Physiol.

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The heart is viscoelastic, meaning its compliance is inversely proportional to the speed at which it stretches. During diastolic filling, the left ventricle rapidly expands at rates where viscoelastic forces impact ventricular compliance. In heart disease, myocardial viscoelasticity is often increased and can directly impede diastolic filling to reduce cardiac output. Thus, treatments that reduce myocardial viscoelasticity may provide benefit in heart failure, particularly for patients with diastolic heart failure. Yet, many experimental techniques either cannot or do not characterize myocardial viscoelasticity, and our understanding of the molecular regulators of viscoelasticity and its impact on cardiac performance is lacking. Much of this may stem from a reliance on techniques that either do not interrogate viscoelasticity (i.e., use non-physiological rates of strain) or techniques that compromise elements that contribute to viscoelasticity (i.e., skinned or permeabilized muscle preparations that compromise cytoskeletal integrity). Clinically, cardiac viscoelastic characterization is challenging, requiring the addition of strain-rate modulation during invasive hemodynamics. Despite these challenges, data continues to emerge demonstrating a meaningful contribution of viscoelasticity to cardiac physiology and pathology, and thus innovative approaches to characterize viscoelasticity stand to illuminate fundamental properties of myocardial mechanics and facilitate the development of novel therapeutic strategies.

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What is the normal haemodynamic response to passive leg raise? A study of healthy volunteers

Cited by 11 publications

References 26 publications

Can passive leg raise predict the response to fluid resuscitation in ED?

Can passive leg raise predict the response to fluid resuscitation in ED?

The Role of Passive legs Raising Position in Hypovolemic Shock: A Case Report and Review of the Literature

Need for Speed: The Importance of Physiological Strain Rates in Determining Myocardial Stiffness

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