UMEM Educational Pearls

Title: Passive Leg Raise

Category: Critical Care

Keywords: passive leg raise, arterial pressure, pulse pressure variation, volume responsiveness, fluid resuscitation (PubMed Search)

Posted: 9/20/2016 by Mike Winters, MBA, MD
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Pitfalls with PLR

  • The passive leg raise (PLR) test has become a popular method to assess volume responsiveness in critically ill patients.
  • PLR mobilizes a volume of approximately 150-300 mL and can be used in spontaneously breathing patients, those receiving positive pressure ventilation, or those with various arrhythmias. 
  • In order to properly perform the PLR, you must have a method to monitor cardiac output. (See previously pearl on 7/26/16).
  • Pitfall: Simply monitoring arterial blood pressure alone is not a sufficient method to assess a positive PLR.
  • Pitfalls:Risks of performing a PLR include increased intracranial pressure, reduced cerebral blood flow, and decreased pulmonary compliance.

References

Aneman A, Sondergaard S. Understanding the passive leg raising test. Intensive Care Med. 2016; 42:1493-5.