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What is the normal haemodynamic response to passive leg raise? A study of healthy volunteers
  1. Mohammed H Elwan1,2,
  2. Ashraf Roshdy3,4,
  3. Joseph A Reynolds2,
  4. Eman M Elsharkawy5,
  5. Salah M Eltahan5,
  6. Timothy J Coats2
  1. 1 Department of Emergency Medicine, Alexandria University, Alexandria, Egypt
  2. 2 Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
  3. 3 Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt
  4. 4 General Intensive Care Unit, Queen Elizabeth, Lewisham and Greenwich NHS Trust, London, UK
  5. 5 Department of Cardiology, Alexandria University, Alexandria, Egypt
  1. Correspondence to Dr Mohammed H Elwan, Emergency Medicine Academic Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK; mohammed.elwan{at}


Objective Passive leg raise (PLR) is used as self-fluid challenge to optimise fluid therapy by predicting preload responsiveness. However, there remains uncertainty around the normal haemodynamic response to PLR with resulting difficulties in application and interpretation in emergency care. We aim to define the haemodynamic responses to PLR in spontaneously breathing volunteers using a non-invasive cardiac output monitor, thoracic electrical bioimpedance, TEB (PLR-TEB).

Methods We recruited healthy volunteers aged 18 or above. Subjects were monitored using TEB in a semirecumbent position, followed by PLR for 3 min. The procedure was repeated after 6 min at the starting position. Correlation between the two PLRs was assessed using Spearman’s r (rs). Agreement between the two PLRs was evaluated using Cohen Kappa with responsiveness defined as ≥10% increase in stroke volume. Parametric and non-parametric tests were used as appropriate to evaluate statistical significance of baseline variables between responders and non-responders.

Results We enrolled 50 volunteers, all haemodynamically stable at baseline, of whom 49 completed the study procedure. About half of our subjects were preload responsive. The ∆SV in the two PLRs was correlated (rs=0.68, 95% CI 0.49 to 0.8) with 85% positive concordance. Good agreement was observed with Cohen Kappa of 0.67 (95% CI 0.45 to 0.88). Responders were older and had significantly lower baseline stroke volume and cardiac output.

Conclusion Our results suggest that the PLR-TEB is a feasible method in spontaneously breathing volunteers with reasonable reproducibility. The age and baseline stroke volume effect suggests a more complex underlying physiology than commonly appreciated. The fact that half of the volunteers had a positive preload response, against the 10% threshold, leads to questions about how this measurement should be used in emergency care and will help shape future patient studies.

  • acute medicine-other
  • cardiac care
  • emergency department
  • emergency care systems, emergency departments

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  • Contributors MHE conducted the study procedure, data analysis and final write-up. AR contributed to study design, critical revision and editing. JAR assisted in data analysis. EME and SME contributed to study design. TJC contributed to study design, critical revision and editing. MHE is responsible for the overall content as guarantor.

  • Funding MHE is funded by Newton-Mosharafa PhD Fund.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University of Leicester Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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