{"id":357,"date":"2017-01-16T11:57:00","date_gmt":"2017-01-16T11:57:00","guid":{"rendered":"http:\/\/www.deltexmedical.com\/decision_tree\/?page_id=357"},"modified":"2025-10-10T13:08:11","modified_gmt":"2025-10-10T12:08:11","slug":"passive-leg-raise-plr","status":"publish","type":"page","link":"https:\/\/www.deltex-academy.com\/decision_tree\/passive-leg-raise-plr\/","title":{"rendered":"Passive leg raise (PLR)"},"content":{"rendered":"<style>.entry-title {display:none;}<br \/><\/style>\n<style>.site-info {display: none;}<br \/><\/style>\n<h2 style=\"text-align: center;\"><strong><span style=\"color: #003087;\">PASSIVE LEG RAISE (PLR)<\/span><\/strong><\/h2>\n<div class='content-column one_half'><p>The PLR test is a bedside assessment to determine fluid responsiveness. The test involves raising a patient&#8217;s legs (to at least 45 degrees) to induce a gravitational transfer of venous blood from the legs into the central circulation. The resulting effect is a transient increase in cardiac preload of ~150-300 mL. If the patient is fluid responsive, there will be an increase in right ventricular preload, right CO, left ventricular filling, and consequently <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\">CO<\/a> [1].<\/p>\n<p>A PLR test is a brief and reversible &#8216;self volume challenge&#8217;. However, because the potential effects are not always sustained, the haemodynamic effects of the challenge should be assessed in the 30-90 s following the onset of the test.<\/p><\/div>\u00a0<div class='content-column one_half last_column'><div style=\"padding-top:30px;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-358 size-full\" src=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/plr.png\" width=\"967\" height=\"673\" srcset=\"https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/plr.png 967w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/plr-300x209.png 300w, https:\/\/www.deltex-academy.com\/decision_tree\/wp-content\/uploads\/2017\/01\/plr-768x535.png 768w\" sizes=\"auto, (max-width: 709px) 85vw, (max-width: 909px) 67vw, (max-width: 1362px) 62vw, 840px\" \/><\/div><\/div><div class='clear_column'><\/div><\/p>\n<p>When assessing the haemodynamic response to a PLR test it is important to use a technology that directly measures CO,\u00a0with sufficient <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/new-accuracy-and-precision\/\" data-cke-saved-href=\"page:336770387\">precision<\/a> to measure a 10-15% change in <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\" target=\"_blank\">SV\/CO.<\/a>\u00a0It should not be assessed by the simple measurement of BP. Oesophageal Doppler-measured changes in <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/stroke-volume-and-cardiac-output\/\" target=\"_blank\">SV\/CO <\/a>have been shown to be more accurate at predicting fluid responsiveness than arterial pulse pressure [2] and [3].<\/p>\n<p>When conducting a PLR, it is important to consider the following [1]and [3]:<\/p>\n<ul>\n<li>Avoiding pain-induced sympathetic stimulation and therefore changes in HR is important to ensure validity. Movement from the 45 degree semi-recumbent to the PLR position does not induce hip flexion and is the simplest way to preform the test.<\/li>\n<li>PLR should be performed using the bed mechanism and not by manually lifting the patient&#8217;s legs.<\/li>\n<li>Not moving the thorax to below the horizontal position to avoid gastric inhalation.<\/li>\n<li>Avoiding PLR in patients with head trauma in case of increases in intracerebral pressure.<\/li>\n<li>Consider the effect of elastic compression stockings on reducing the venous reservior recruited by the PLR.<\/li>\n<li>CO should be measured before, during and after the PLR.<\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">The decision to give intravenous\u00a0fluid based on PLR must be made on an individual basis depending on the\u00a0clinical situation and is\u00a0likely to include the following: haemodynamic\u00a0instability, signs of circulatory shock, preload\u00a0responsiveness and where there are limited risks of overload.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">\u200bPLR is\u00a0likely to be more labour intensive than a fluid\u00a0challenge.<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">\u200bWhen assessing preload responsiveness to a PLR, the monitoring tool needs to be both highly precise and FAST. ODM is precise [4] and\u00a0also\u00a0displays beat to beat changes.\u00a0<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">PLR has not been studied in terms of its impact on\u00a0outcomes.\u200b<\/span><\/li>\n<\/ul>\n<h3><strong><span style=\"color: #003087;\">References<\/span><\/strong><\/h3>\n<ol>\n<li>Monnet, X. and Teboul, J.L.\u00a0<i>Passive leg raising.<\/i> Intensive Care Med, 2008. <b>34<\/b>(4): p. 659-63.<\/li>\n<li>Monnet, X., et al., <em>Passive leg raising predicts fluid responsiveness in the critically ill<\/em>. Crit Care Med, 2006. 34(5): p. 1402-7.<\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">\u200bMoney, X and Teboul J. L., <em>\u00a0Passive leg raising: five rules, not a drop of fluid!<\/em>\u00a0Critical Care 2015.\u00a014;19:18.<\/span><\/li>\n<li><span style=\"color: #000000; font-family: arial, helvetica, sans-serif;\">\u200bSinger, M. and Bennett, D.\u00a0<em>\u200bContinuous hemodynamic monitoring by\u00a0<\/em><i>oesophageal\u00a0Doppler.\u00a0<\/i>\u200bCritical Care\u00a0Medicine 17(5): p. 447-452.<\/span><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>PASSIVE LEG RAISE (PLR) \u00a0 When assessing the haemodynamic response to a PLR test it is important to use a technology that directly measures CO,\u00a0with sufficient precision to measure a 10-15% change in SV\/CO.\u00a0It should not be assessed by the simple measurement of BP. Oesophageal Doppler-measured changes in SV\/CO have been shown to be more &hellip; <a href=\"https:\/\/www.deltex-academy.com\/decision_tree\/passive-leg-raise-plr\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> &#8220;Passive leg raise (PLR)&#8221;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-357","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/357","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/comments?post=357"}],"version-history":[{"count":5,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/357\/revisions"}],"predecessor-version":[{"id":1315,"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/pages\/357\/revisions\/1315"}],"wp:attachment":[{"href":"https:\/\/www.deltex-academy.com\/decision_tree\/wp-json\/wp\/v2\/media?parent=357"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}