Monday September 21, 2009
Passive Leg Raising or Raising HOB to determine volume status

As we are getting more and more tangled with technology, unfortunately we are losing simple bedside maneuvers which were once integral part of physical examination.

CVP (central venous pressure) is a great way to determine volume status but even before central line get place, simple tricks at bedside may give assessment of volume status and may begin management even earlier. If blood pressure improves by just passively raising legs for 2-4 minutes or blood pressure drop by raising head of bed (HOB) to 45 degree, patient is probably hypovolumic.

See references, where these tests have been validated in clinical trials.


References: click to get abstract/article

1. Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients - Chest. 2002;121:1245-1252.)

2. Passive leg raising predicts fluid responsiveness in the critically ill - Critical Care Medicine. 34(5):1402-1407, May 2006

3. Passive leg raising-induced changes in mean radial artery pressure can be used to assess preload dependence - poster from 27th International Symposium on Intensive Care and Emergency Medicine, Brussels, Belgium. 27–30 March 2007, Critical Care 2007, 11(Suppl 2):P307