Bedside Echocardiography and Passive Leg Raise as a Measure of Volume Responsiveness in the Emergency Department

J Ultrasound Med. 2019 May;38(5):1319-1326. doi: 10.1002/jum.14812. Epub 2018 Oct 15.


Objectives: The aim of this study was to investigate the value of bedside echocardiography with a passive leg raise as a noninvasive marker of volume responsiveness.

Methods: This work was a prospective observational study of patients with end-stage renal disease presenting to the emergency department. The left ventricular outflow tract (LVOT) velocity time integral (VTI) was obtained. Measurements before and after dialysis as well as before and after the passive leg raise were recorded.

Results: Fifty-four patients were enrolled, in whom the mean volume of fluid removed ± SD was 3.89 ± 0.91 L. In the predialysis cohort, the mean LVOT VTI was 28.05 cm (95% confidence interval [CI], 26.55-29.55 cm). After the passive leg raise, the mean VTI was 28.52 cm (95% CI, 26.98-30.07 cm). In the postdialysis cohort, the mean VTI was 30.31 cm (95% CI, 28.92-31.69 cm), and it increased to 34.91 cm (95% CI, 33.11-36.72 cm) after the passive leg raise. The Δ VTI values were 1.83% (95% CI, 0.12%-3.55%) in the predialysis group and 15.05% (95% CI, 12.76%-17.34%) in the postdialysis cohort. When stratified by fluid removal, the mean Δ VTI values after hemodialysis were 12.64% (95% CI, 9.79%-15.49%) and 16.84% (95% CI, 13.47%-20.22%) for patients who had less than 4 L and 4 L or greater removed, respectively. In patients without congestive heart failure, the Δ VTI was 15.28% (95% CI, 12.25%-18.32%), whereas for those with congestive heart failure, the mean change was 14.63% (95% CI, 10.91%-18.35%).

Conclusions: The LVOT VTI in conjunction with a passive leg raise seems to correlate with the volume status and volume responsiveness.

Keywords: echocardiography; emergency medicine; fluid responsiveness; hemodialysis; left ventricular outflow tract; passive leg raise; velocity time integral.

Publication types

  • Observational Study

MeSH terms

  • Echocardiography / methods*
  • Emergency Service, Hospital
  • Female
  • Heart Failure / complications
  • Heart Failure / physiopathology*
  • Heart Ventricles / physiopathology*
  • Humans
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy
  • Leg / physiology
  • Male
  • Middle Aged
  • Patient Positioning / methods*
  • Point-of-Care Testing*
  • Prospective Studies
  • Renal Dialysis
  • Stroke Volume / physiology