Measurements (2): EtCO2 monitoring ca be regarded as a noninvasive surrogate of cardiac index during PLR when no device is available for measuring cardiac index.
Treatment (1): - PLR should start from the semi-recumbent and not the supine position.
- The PLR effects must be assessed by a direct measurement of cardiac output and not by the simple measurement of blood pressure.
- The technique used to mesure cardiac output during PLR must be able to detect short-term and transient changes since the PLR effects may vanish after 1 minute.
- Cardiac output must be measured not only before and during PLR but also after PLR when the patient has been moved back to the semi-recumbent position, in order to check that it returns to its baseline.
- Pain, cough, discomfort, and awakening could provoke adrenergic stimulation, resulting in mistaken interpretation of cardiac output changes.
References: - Xavier Monnet et al. Passive leg raising: five rules, not a drop of fluid! Critical Care. 2015;19:18:Â full text | pdf.
- Xavier Monnet et al. End-tidal carbon dioxide is better than arterial pressure for predicting volume responsiveness by the passive leg raising test. Intensive Care Med. 2013;39:93-100: full text | pdf.
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