Passive leg raise as a noninvasive nursing intervention to predetermine fluid responsiveness in patients with sepsis in the emergency department

BACKGROUND: Sepsis-related hypotension is treated by administration of intravenous fluids. Excess fluid volume can result in pulmonary edema and respiratory failure. Monitoring increases in patients' end-tidal carbon dioxide (ETCO2) in response to a passive leg raise (PLR) is a noninvasive method to evaluate fluid responsiveness. OBJECTIVE: To determine the effectiveness of PLR and ETCO2 monitoring after initial fluid resuscitation among spontaneously breathing or intubated patients with sepsis. METHODS: Using a quantitative comparative design, the study compared the total amount of fluid administered and outcomes between two cohorts of patients with sepsis in the emergency department (ED): the preintervention retrospective cohort (n = 259) who did not receive PLR, and the intervention prospective sample (n = 77) who received the PLR intervention. Supplementary analyses divided the intervention group into those who did (n = 28) and did not (n = 49) meet criteria for fluid responsiveness, comparing fluid administration totals. RESULTS: Patients who received PLR had a higher total fluid volume administered than the preintervention group (P < .001). Tachycardia was more common in the preintervention group than in the intervention group (P < .001). Of the patients who received PLR, 64% were identified as negative fluid responders. These patients had lower mean total fluid administration, although the difference was not statistically significant (P = .06). CONCLUSION: This study demonstrates that PLR can be instrumental in assessing fluid responsiveness among ED patients with sepsis who are spontaneously breathing or intubated.