Passive Leg Raise in Sepsis Management

Introduction to Passive Leg Raise

The Campaña Sobreviviendo a la Sepsis guidelines recommend the passive leg raise (PLR) test as a superior method to static measurements for predicting fluid response in septic patients, as it acts as a reversible endogenous volume challenge, mobilizing approximately 300 mL of blood from the lower extremities to the thorax 1, 2, 3

Dynamic measures like PLR have demonstrated higher diagnostic accuracy than static measurements, such as central venous pressure, for predicting which patients will benefit from fluid administration, with a positive likelihood ratio of 11 (95% CI 7.6-17) and a pooled specificity of 92% 2, 4

The American College of Critical Care Medicine and the Surviving Sepsis Campaign recommend using PLR to guide fluid administration in septic patients, with a threshold of at least 30 mL/kg of crystalloids in the first 3 hours 2, 4
The PLR test is particularly useful for deciding whether to continue with fluids after the initial bolus, with an increase of ≥8.1% in the stroke volume index (SVI) during PLR predicting fluid response with a sensitivity of 92% and specificity of 70% 1, 2

The PLR may be less reliable in patients with intra-abdominal hypertension or abdominal compartment syndrome, as well as in those with atrial fibrillation or arrhythmias, spontaneous breathing, or low-level pressure support 1, 3
The administration of excessive fluids can cause complications such as pulmonary edema, and PLR can help avoid unnecessary fluid administration 2, 3