Passive Leg Raising

  • X. Monnet
  • C. Richard
  • J. -L. Teboul


Passive leg raising involves the elevation of the lower limbs from the horizontal plane. It was used as an empiric rescue therapy for acute hypotension long before intensive care units (ICUs) were created. The hemodynamic effects of passive leg raising have been progressively elucidated. In view of its simplicity, there is renewed interest in passive leg raising as a means of predicting fluid responsiveness in the critically ill.


Right Ventricular Fluid Responsiveness Stroke Volume Variation Pulse Contour Predict Fluid Responsiveness 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Rutlen DL, Wackers FJ, Zaret BL (1981) Radionuclide assessment of peripheral intravascular capacity: a technique to measure intravascular volume changes in the capacitance circulation in man. Circulation 64:146–152PubMedGoogle Scholar
  2. 2.
    Guyton AC, Lindsey AW, Abernathy B, Richardson T (1957) Venous return at various right atrial pressures and the normal venous return curve. Am J Physiol 189:609–615PubMedGoogle Scholar
  3. 3.
    Thomas M, Shillingford J (1965) The circulatory response to a standard postural change in ischaemic heart disease. Br Heart J 27:17–27PubMedCrossRefGoogle Scholar
  4. 4.
    Rocha P, Lemaigre D, Leroy M, Desfonds P, De Zuttere D, Liot F (1987) Nitroglycerin-induced decrease of carbon monoxide diffusion capacity in acute myocardial infarction reversed by elevating legs. Crit Care Med 15:131–133PubMedCrossRefGoogle Scholar
  5. 5.
    Boulain T, Achard JM, Teboul JL, Richard C, Perrotin D, Ginies G (2002) Changes in BP induced by passive leg raising predict response to fluid loading in critically ill patients. Chest 121:1245–1252PubMedCrossRefGoogle Scholar
  6. 6.
    Bertolissi M, Broi UD, Soldano F, Bassi F (2003) Influence of passive leg elevation on the right ventricular function in anaesthetized coronary patients. Crit Care 7:164–170PubMedCrossRefGoogle Scholar
  7. 7.
    Pozzoli M, Traversi E, Cioffi G, Stenner R, Sanarico M, Tavazzi L (1997) Loading manipulations improve the prognostic value of Doppler evaluation of mitral flow in patients with chronic heart failure. Circulation 95:1222–1230PubMedGoogle Scholar
  8. 8.
    Kyriakides ZS, Koukoulas A, Paraskevaidis IA, et al (1994) Does passive leg raising increase cardiac performance? A study using Doppler echocardiography. Int J Cardiol 44:288–293PubMedCrossRefGoogle Scholar
  9. 9.
    Wong DH, Tremper KK, Zaccari J, Hajduczek J, Konchigeri HN, Hufstedler SM (1988) Acute cardiovascular response to passive leg raising. Crit Care Med 16:123–125PubMedCrossRefGoogle Scholar
  10. 10.
    Wong DH, Watson T, Gordon I, et al (1991) Comparison of changes in transit time ultrasound, esophageal Doppler, and thermodilution cardiac output after changes in preload, afterload, and contractility in pigs. Anesth Analg 72:584–588PubMedGoogle Scholar
  11. 11.
    Monnet X, Rienzo M, Osman D, et al (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407PubMedCrossRefGoogle Scholar
  12. 12.
    Gaffney FA, Bastian BC, Thal ER, Atkins JM, Blomqvist CG (1982) Passive leg raising does not produce a significant or sustained autotransfusion effect. J Trauma 22:190–193PubMedCrossRefGoogle Scholar
  13. 13.
    Tomaselli CM, Kenney RA, Frey MA, Hoffler GW (1987) Cardiovascular dynamics during the initial period of head-down tilt. Aviat Space Environ Med 58:3–8PubMedGoogle Scholar
  14. 14.
    Reich DL, Konstadt SN, Raissi S, Hubbard M, Thys DM (1989) Trendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery disease. Crit Care Med 17:313–317PubMedCrossRefGoogle Scholar
  15. 15.
    Dodek P, Keenan S, Cook D, et al (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–313PubMedGoogle Scholar
  16. 16.
    Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008PubMedCrossRefGoogle Scholar
  17. 17.
    Monnet X, Teboul JL (2006) Invasive measures of left ventricular preload. Curr Opin Crit Care 12:235–240PubMedCrossRefGoogle Scholar
  18. 18.
    Pinsky MR, Payen D (2005) Functional hemodynamic monitoring. Crit Care 9:566–572PubMedCrossRefGoogle Scholar
  19. 19.
    Michard F, Boussat S, Chemla D, et al (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  20. 20.
    Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873PubMedCrossRefGoogle Scholar
  21. 21.
    Reuter DA, Felbinger TW, Schmidt C, et al (2002) Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 28:392–398PubMedCrossRefGoogle Scholar
  22. 22.
    Berkenstadt H, Margalit N, Hadani M, et al (2001) Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg 92:984–989PubMedCrossRefGoogle Scholar
  23. 23.
    Monnet X, Rienzo M, Osman D, et al (2004) Noninvasive assessment of volume responsiveness in patients with spontaneous respiratory activity and/or arrhythmias: response to passive legs raising using transesophageal Doppler. Am J Respir Crit Care Med 169:A343 (abst)Google Scholar
  24. 24.
    Heenen S, De Backer D, Vincent JL (2006) How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care 10:R102PubMedCrossRefGoogle Scholar
  25. 25.
    Dark PM, Singer M (2004) The validity of trans-esophageal Doppler ultrasonography as a measure of cardiac output in critically ill adults. Intensive Care Med 30:2060–2066PubMedCrossRefGoogle Scholar
  26. 26.
    Roeck M, Jakob SM, Boehlen T, Brander L, Knuesel R, Takala J (2003) Change in stroke volume in response to fluid challenge: assessment using esophageal Doppler. Intensive Care Med 29:1729–1735PubMedCrossRefGoogle Scholar
  27. 27.
    Cariou A, Monchi M, Joly LM, et al (1998) Noninvasive cardiac output monitoring by aortic blood flow determination: evaluation of the Sometec Dynemo-3000 system. Crit Care Med 26:2066–2072PubMedCrossRefGoogle Scholar
  28. 28.
    Lafanechere A, Pene F, Goulenok C, et al (2006) Changes in aortic blood flow induced by passive leg raising predict fluid responsiveness in critically ill patients. Crit Care 10:R132PubMedCrossRefGoogle Scholar
  29. 29.
    Ridel C, Lamia B, Monnet X, Richard C, Teboul JL (2006) Passive leg raising and fluid responsiveness during spontaneous breathing: pulse contour evaluation. Intensive Care Med 32:S81 (abst)Google Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • X. Monnet
    • 1
  • C. Richard
    • 1
  • J. -L. Teboul
    • 1
  1. 1.Department of Medical Intensive CareCentre Hospitalier Universitaire de BicêtreLe Kremlin-BicêtreFrance

Personalised recommendations