The effectiveness of passive leg raising in the prediction of fluid responsiveness

Abstract

Overview of the topic: In critically-ill patients with inadequate tissue perfusion, fluid resuscitation with the aim of establishing haemodynamic stability is essential. However, fluid administration is not always requisite. Clinical studies have indicated that only half of these patients respond to the fluids administered (Marik, 2009). Passive leg raising (PLR) has recently been suggested as a test for predicting preload responsiveness. In this dissertation, the effectiveness of PLR in the prediction of fluid responsiveness will be studied. The research question: For critically-ill patients with inadequate tissue perfusion, does the use of the passive leg raising test predict fluid responsiveness, thus preventing fluid overload? PICO elements: (P) critically-ill adult patients with inadequate tissue perfusion, (I) passive leg raising test, (C) no intervention, (O) prediction of fluid responsiveness, prevention of fluid overload. Inclusion criteria: Adults, English language full-text papers published from 2006 to date, patients showing signs of inadequate tissue perfusion. Exclusion criteria: Paediatrics, Pregnant women, patients with contraindications to PLR and patients with amputated lower limbs. Search outcomes: Combined keywords and alternative terms were searched in six databases. A total of eight key prospective cohort studies were identified. Methods of appraisal: The cohort study checklist from the CASP programme was used to critically appraise the articles. Results: Overall, PLR showed a good diagnostic performance in prediction of fluid responsiveness. However, heterogeneity between studies created some inconsistencies. Hence, it can be concluded that these results should be interpreted vigilantly. Implications and recommendations: Further research is still required due to the low number of studies published to date. Moreover, further education needs to be provided to health care professionals working in intensive care regarding the early detection of signs of inadequate tissue perfusion and the appropriate technique for PLR.