Passive lag raise (PLR) is a simulation of a fluid challenge crucial for stroke management (Si et al., 2016). However, it is often underrated (Monnet & Teboul, 2015). There is currently no uniform standard for using PLR (Lam, Lau, Lam, & Yan, 2017).
PLR will ostensibly help avoid fluid overload (Naik, & Durieux, 2014). PLR allows for an increase in the mean systemic pressure (Lam et al., 2017). PLR simulates a change in the fluid volume (Lam et al., 2017). Trendelenburg position should be considered inferior to PLR (Bapat et al., 2017).
PICOT and Objectives
n hypotensive patients, does the use of the passive leg raise (PLR) technique work better than the application of the Trendelenburg strategy or no intervention at all in improving the BP rates?
P– Hypotensive patients
I– Passive leg raise
C– No intervention or Trendelenburg
O– Outcomes improved BP
PLR has a greater effect on hypotensive patients than the Trendelenburg position or the absence of any intervention.
There is no difference in the effects of the PLR approach, the Trendelenburg position, and the absence of any intervention in managing hypotension.
Shelter’s Model was utilized to conduct a systematic review of the available evidence and determine the benefits of PLR compared to the use of the Trendelenburg position. The framework allowed designing the protocol that could be applied to carry out the necessary procedures and manage the fluid volume in patients with hypotension.
- Cochraine and PubMed were used as the key search engines;
- The studies that addressed the sue of PLR were incorporated into the review.;
- Peer-reviewed articles published in 2012 and later were used in the study.
- The use of appropriate methodology can be viewed as the primary strength of the reviewed studies. The limitations associated with the number of participants and the scale of the research can be considered the key weaknesses.
The PLR approach is superior to the use of the Trendelenburg position (Bapat et al., 2017);
- Auto-transfusion from the lower limbs to the central circulation allows increasing blood pressure (Dalabih, Rischard, & Mosier, 2014);
- Active use of PLR will allow controlling the fluid volume better (Lempke, Green, Murray, & Stanek, 2017);
- Cardiac preload and fluid responsiveness can be increased with the help of PLR (Si et al., 2016);
- Significance of results/implications
- The results allow for a rapid improvement in patient outcomes by adjusting the current approach toward hypotension management.
Promotion of nurse training will become the basis for a sharp rise in the efficacy of the nursing services (Naik & Durieux, 2014). Clear and detailed instructions regarding the management of hypotension patients’ needs must be provided to the staff. Instructing nurses to transfer no more than 300 mL of venous blood during the procedure. Teaching nurses to detect transient changes that may occur in patients. Promoting the significance of maintaining the changes consistent (Saleh, 2016; Manderville, 2012).
Bapat, M., Afzal, A., Chabbott, D., Fung, D., Mughal, M. F., Le, H. V., … Lazar, L. (2017). Changes in carotid radial pulse wave velocity induced by hyperemia and passive leg rising. International Journal of Clinical Cardiology & Research, 1(1), 43-47.
Dalabih, M., Rischard, F., & Mosier, J. M. (2014). What’s new: The management of acute right ventricular decompensation of chronic pulmonary hypertension. Intensive Care Medicine, 40(12), 1930–1933. Web.
Lam, S. M., Lau, A. C. W., Lam, R. P. K., & Yan, W. W. (2017). Clinical management of sepsis. Hong Kong Medical Journal, 23(3), 296-305. Web.
Lempke, R., Green, I., Murray, C., & Stanek, J. (2017). The effectiveness of PNF vs. static stretching on increasing hip flexion range of motion. Journal of Sport Rehabilitation, 9(6), 1-15. Web.
Manoach, S. (2014). Plethysmography variability index and pre-cardiopulmonary bypass phlebotomy in children: Ideal physiology and clinical practice. Journal of Pediatric Intensive Care, 3(1), 1-7. Web.
Manderville, J. C. (2012). Can transthoracic echocardiography be used to predict fluid responsiveness in the critically ill patient? A systematic review. Critical Care Research and Practice, 2012(513480), 1-9. Web.
Monnet, X., & Teboul, J. L. (2015). Passive leg raising: Five rules, not a drop of fluid! Critical Care, 19(1), 18-20. Web.
Naik, B. I., & Durieux, N. E. (2014). Hemodynamic monitoring devices: Putting it all together. Best Practice & Research Clinical Anaesthesiology, 28(4), 477-488. Web.
Saleh, A. S. (2016). Is the concept of fluid responsiveness evidence-based? Intensive Care Medicine, 42(7):1187-1188. Web.
Si, X., Cao, D., Wu, J., Chen, J., Liu, Z., Chen, M., … Guan, X. (2016). Diagnostic accuracy of transthoracic echocardiography to predict fluid responsiveness by passive leg raising in the critically ill: A meta-analysis. Open Journal of Emergency Medicine, 4(1), 83-92. Web.