Medicine:Passive leg raise
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| Passive leg raise | |
|---|---|
| Medical diagnostics | |
 passive leg raising test | |
| Synonyms | Shock position |
Passive leg raise, also known as shock position, is a treatment for shock or a test to predict the response to rapid fluid loading[1] during fluid resuscitation.[2]
The position consists of a person lying flat on their back with their legs elevated 8–12 inches (200–300 mm).[3][4][5][6] This is done to keep the legs above the heart, helping blood flow to the heart via gravity. This increases the volume of blood available to the heart (cardiac preload) by 150-300 milliliters.[2] The real-time effects of this on parameters such as blood pressure and heart rate assist medical professionals.[7][8]
In a clinical setting, a patient's bed may be moved from a semi-recumbent position (half sitting, half laying down) to a recumbent position (lying down) position with the legs raised. This is theorized to cause additional mobilisation of blood from the gastrointestinal circulation.[9][10]
The assessment is easier with invasive monitoring (such as an arterial catheter). The monitoring provides real-time measurements of cardiac output, which helps keep track of blood pressure or pulse while they amplify during this procedure. Cardiac output can be measured by arterial pulse contour analysis, echocardiography, esophageal Doppler, or contour analysis of the volume clamp-derived arterial pressure. Any bronchial secretions must be aspirated before performing this test.
The legs should not be manually elevated because this may provoke pain, discomfort, or awakening, leading to adrenergic stimulation and false cardiac output readings by increasing heart rate. After the maneuver, the bed should be placed back into semi-recumbent position, and cardiac output should be measured again. The cardiac output should return to the values measured before the initiation of this maneuver. This test can be used to assess fluid responsiveness without any fluid challenge, which can lead to fluid overload.[11] Compression stockings should be removed before the test so that adequate volume of blood will return to the heart during the maneuver.[12] The physiology of assessing fluid responsiveness via passive leg raise requires increasing systemic venous return without altering cardiac function - a form of functional hemodynamic monitoring.[13]
Several studies have shown 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.[13]
Placing the person in the Trendelenburg position does not work as blood vessels are highly compliant and expand as a result of the increased volume locally. A more suitable option would be the use of vasopressors.[3][4][5][6]
See also
References
- ↑ Gillis, Holly C; Walia, Hina; Tumin, Dmitry; Bhalla, Tarun; Tobias, Joseph D (17 September 2018). "Rapid fluid administration: an evaluation of two techniques". Medical Devices: Evidence and Research (Dove Medical Press Limited) 11: 331–336. doi:10.2147/MDER.S172340. PMID 30271225.
- ↑ 2.0 2.1 "Passive leg raising". Intensive Care Med 34 (4): 659–63. April 2008. doi:10.1007/s00134-008-0994-y. PMID 18214429.
- ↑ 3.0 3.1 Irwin, Richard S.; Rippe, James M. (January 2003). Intensive Care Medicine. Lippincott Williams & Wilkins, Philadelphia & London. ISBN 978-0-7817-3548-3. http://www.lww.com/product/?0-7817-3548-3.
- ↑ 4.0 4.1 Marino, Paul L. (September 2006). The ICU Book. Lippincott Williams & Wilkins, Philadelphia & London. ISBN 978-0-7817-4802-5. http://www.lww.com/product/?978-0-7817-4802-5. Retrieved 2018-10-24.
- ↑ 5.0 5.1 "Fundamental Critical Care Support, A standardized curriculum of Critical Care". Society of Critical Care Medicine, Des Plaines, Illinois. http://www.sccm.org/SCCM/FCCS+and+Training+Courses/FCCS/FCCSCourseAdmin.htm.
- ↑ 6.0 6.1 Harrison's Principles of Internal Medicine. http://books.mcgraw-hill.com/medical/harrisons/.
- ↑ Boulain, Thierry; Achard, Jean-Michel; Teboul, Jean-Louis; Richard, Christian; Perrotin, Dominique; Ginies, Guy (April 2002). "Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients". Chest (The American College of Chest Physicians) 121 (4): 1245–1252. doi:10.1378/chest.121.4.1245. PMID 11948060. https://doi.org/10.1378/chest.121.4.1245.
- ↑ "Diagnosis of central hypovolemia by using passive leg raising". Intensive Care Med 33 (7): 1133–8. July 2007. doi:10.1007/s00134-007-0642-y. PMID 17508202.
- ↑ "Passive leg raising for predicting fluid responsiveness: importance of the postural change". Intensive Care Med 35 (1): 85–90. September 2008. doi:10.1007/s00134-008-1293-3. PMID 18795254.
- ↑ "Prediction of volume responsiveness in critically ill patients with spontaneous breathing activity". Curr Opin Crit Care 14 (3): 334–9. June 2008. doi:10.1097/MCC.0b013e3282fd6e1e. PMID 18467896.
- ↑ Xavier, Monnet (14 January 2015). "Passive leg raising: five rules, not a drop of fluid!". Critical Care 19 (18): 237. doi:10.1186/s13054-014-0708-5. PMID 25658678.
- ↑ Jacob Chakco, Cyril; P Wise, Matt; J Frost, Paul (1 June 2015). "Passive leg raising and compression stockings: a note of caution". Critical Care 19 (237): 237. doi:10.1186/s13054-015-0955-0. PMID 26028257.
- ↑ 13.0 13.1 Monnet, X; Marik, PE; Teboul, JL (December 2016). "Prediction of fluid responsiveness: an update.". Annals of Intensive Care 6 (1): 111. doi:10.1186/s13613-016-0216-7. PMID 27858374.
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