Focused Cardiac Ultrasound to Measure Volume Responsiveness Before and After Passive Leg Raise

How to predict volume responsiveness using focused cardiac ultrasound and a passive leg raise maneuver.

Intravenous fluid resuscitation is mainstay in the management of patients with hypotension and/or shock. The rationale is to restore circulating blood volume by augmenting cardiac preload resulting in increased ventricular stroke volume and systemic perfusion pressure. However, predicting which patients will respond to fluid resuscitation is challenging and over-resuscitation leads to edema of multiple organ systems and is associated with increased mortality. This video depicts how to predict volume responsiveness with focused cardiac ultrasound (FoCUS). The process involves simulating a fluid bolus with a passive leg raise (PLR) and measuring left ventricular outflow tract velocity time integral (LVOT VTI) before and after this maneuver. Using the formula--∆VTI(%)=(VTIpost-PLR – VTIpre-PLR)/[(VTIpost-PLR + VTIpre-PLR)/2] x 100%--a difference of 10%-15% is predictive of fluid responsiveness. We thank Lauren Ward, MD and Jacob Graham, PA-C of the University of Pittsburgh Medical Center, the UPMC CTICU for providing the facilities and resources, and Nate Langer and the UPMC Media Relations Team for their work on the video. Click ja.ma/4iwoe0B for full details.