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Archived Comments for: Passive leg raising: five rules, not a drop of fluid!

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  1. Passive Leg Raising (PLR): « primum non nocere »

    alexandre eghiaian, Gustave Roussy Cancer Campus

    13 July 2015

    Many thanks to the authors for this welcomed reminder about a not so easy to perform method, the PLR (1). However, in our opinion, going further on how to help realizing it is necessary to achieve its safe and efficient use. Firstly, as unexpected side observations from simulation sessions aiming at teaching Picco2® (Maquet) use, we noticed that users almost never hold on to the tracheal tube or venous or arterial lines when tilting the bed for PLR, a safety point that can never be too much emphasized. Secondly, we also noticed that even when knowing them, users tend to forget key points such as checking the pressure transducer level, starting bed tilting at a correct angle, etc. It seemed that the focus on the cardiac output variations (that they also almost never calculated in advance from baseline value) and simultaneous checks and calculations caused a high cognitive load (2), potentially hampering the acquisition of valid data. We therefore propose that a short checklist could be done during the PLR to ensure its safe and correct realization. Check lists are validated as cognitive aids in many circumstances, with a positive impact on patients¿ outcomes (3), (4). It would be a very simple one, including the steps authors mentioned figure 1 and some of the points we raised; we hope to test such a tool in the near future. They may have some limitations (5), but checklists could contribute to help the clinicians doing no harm using PLR. Drs Eghiaian, Suria, Weil. References (1) Monnet X, Teboul JL. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19:18. (2) Miller G. The magical number seven, plus or minus two: some limits to our capacity for processing informations. Psychological Review. 1956; 63:81-97. (3) Haynes A, Weiser T, Berry W, Lipsitz S, Breizat A, Dellinger E, Herbosa T, Joseph S, Kibatala P, Lapitan M, Merry A, Moorthy K, Reznick R, Taylor B, Gawande A; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360(5): 491-9. (4) Winters B, Gurses A, Lehmann H, Sexton J, Rampersad J, Pronovost P. Clinical review: checklists-translating evidence into practice. Crit Care. 2009; 13(6):210. (5) Hilligoss B, Moffatt-Bruce S. The limits of checklists: handoff and narrative thinking. BMJ Qual Saf. 2014; 23(7): 528-33.

    Competing interests

    None to disclose