Passive Leg Raising Does Not Produce a Significant or Sustained Autotransfusion Effect

ArticleinThe Journal of trauma 22(3):190-3 · April 1982with75 Reads
DOI: 10.1097/00005373-198203000-00003 · Source: PubMed
Passive leg raising is widely used to treat hypotension associated with hypovolemia. Presumably gravity causes a central translocation of leg venous blood and an increase in filling pressure, cardiac output, and arterial pressure. Ten healthy volunteers, 25 to 35 years old, had measurements of heart rate, blood pressure, and cardiac output in the supine position after 20 sec and 7 min of 60 degrees passive leg elevation. The protocol was performed 3 and 45 min after the subjects changed from an ambulatory upright to a supine position. Stroke volume and cardiac output increased transiently (8-10%) when the legs were raised after 3 min rest in the supine position. By 7 min of leg elevation, these beneficial effects disappeared. After 45 min supine, leg raising had no effect on stroke volume or cardiac output but increased blood pressure (4 mm Hg) by increasing peripheral resistance (15%). Thus, leg raising, like application of the MAST trousers, fails to produce any sustained increase in cardiac output or stroke volume. Small venous leg volumes and time-dependent changes in the distribution of venous volume and compliance may explain the absence of any sustained 'autotransfusion' effect.
    • "In this study, the effects of PLR in healthy subjects on HR, SV, CO, and TPR in addition to SBP, DBP, and MBP were evaluated using a non-invasive continuous measurement system (Portapres®). Previous studies on PLR in healthy subjects reported transient changes of cardiovascular dynamics by PLR, but failed to show significant lasting effects of PLR [4][5][6][7]. In contrast, the present study revealed significant sustained effects on cardiovascular parameters even at 10 min after the start of PLR. "
    Full-text · Article · Jan 2016 · Journal of clinical anesthesia
    • "Using nuclear scintigraphy, Rutlen et al [33] reported a 30–35% decrease in calf radioactivity after PLR, which corresponds to a blood volume of 150 ml transferred to the intravascular space [8]. Gaffney et al [8] measured an 8–10% increase in CO and SV following PLR. Bivins et al [29] studied blood volume distribution in 15u Trendelenburg position in 10 healthy subjects and found that it resulted in displacement of only 1.8% of total volume centrally. "
    [Show abstract] [Hide abstract] ABSTRACT: To investigate functional hemodynamic response to passive leg raising in healthy pregnant women and compare it with non-pregnant controls. This was a prospective cross-sectional study with a case-control design. A total of 108 healthy pregnant women at 22-24 weeks of gestation and 54 non-pregnant women were included. Cardiac function and systemic hemodynamics were studied at baseline and 90 seconds after passive leg raising using non-invasive impedance cardiography. Trends and magnitudes of changes in impedance cardiography derived parameters of cardiac function and systemic hemodynamics caused by passive leg raising, and preload responsiveness defined as >10% increase in stroke volume or cardiac output after passive leg raising compared to baseline. The hemodynamic parameters in both pregnant and non-pregnant women changed significantly during passive leg raising compared to baseline, but the magnitude and trend of change was similar in both groups. The stroke volume increased both in pregnant (p = 0.042) and non-pregnant (p = 0.018) women, whereas the blood pressure and systemic vascular resistance decreased (p<0.001) following passive leg raising in both groups. Only 14.8% of pregnant women and 18.5% of non-pregnant women were preload responsive and the difference between groups was not significant (p = 0.705). Static measures of cardiovascular status are different between healthy pregnant and non-pregnant women, but the physiological response to passive leg raising is similar and not modified by pregnancy at 22-24 weeks of gestation. Whether physiological response to passive leg raising is different in earlier and later stages of pregnancy merit further investigation.
    Full-text · Article · Apr 2014
    • "Twenty-one studies that evaluated the hemodynamic effects of PLR 1 [5,6,12,14,15,22232425262728293031323334353637 were included. In total, 431 subjects were studied, with an average of 14 patients per study. "
    [Show abstract] [Hide abstract] ABSTRACT: Hypovolemia is a common clinical problem. The Trendelenburg position and passive leg raising (PLR) are routinely used in the initial treatment while awaiting fluid resuscitation. In this meta-analysis, we evaluated the hemodynamic effects of PLR and Trendelenburg positioning to determine which position had the most optimal effect on cardiac output (CO). Databases were searched for prospective studies published between 1960 and 2010 in normovolemic or hypovolemic humans; these studies had to investigate the hemodynamic effects within 10 minutes of a postural change from supine. Twenty-one studies were included for PLR (n=431) and 13 studies for Trendelenburg position (n=246). Trendelenburg position increased mean arterial pressure (MAP). Cardiac output increased 9%, or 0.35 L/min, at one minute of head-down tilt. Between 2 and 10 minutes, this increase in CO decreased to 4%, or 0.14 L/min, from baseline. Cardiac output increased at one minute of leg elevation by 6%, or 0.19 L/min. The effect persisted after this period by 6%, or 0.17 L/min. Both Trendelenburg and PLR significantly increased CO, but only PLR seemed to sustain this effect after one minute. Although the Trendelenberg position is a common maneuver for nurses and doctors, PLR may be the better intervention in the initial treatment of hypovolemia.
    Full-text · Article · Dec 2012
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