Research Article
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Does Passive Leg Raising Affect Intracranial Pressure in Healthy Volunteers?

Year 2021, Volume: 3 Issue: 1, 29 - 32, 15.04.2021

Abstract

Background:
Ultrasonographic optic nerve sheath diameter (ONSD) measurements taken at the bedside are used to estimate intracranial pressure. Passive leg raising (PLR) is a maneuver that can test whether intravascular volume expansion can improve cardiac output in the presence of circulatory failure. In this study, we investigated whether the PLR maneuver has an effect on ONSD in healthy adults.
Materials:
This prospective study consisted of 32 healthy volunteers. ONSD measurements were taken in three consecutive steps. In the first, patients were placed in a supine position on a flat stretcher. In the second stage, patients were brought to the semi-recumbent position by lifting the stretcher head by 45°. In the third stage, patients were raised in a position with their legs 45° above their trunk.
Results:
The ONSD measurements of the subjects for the right eye were 4.75 (0.22) mm for the first position, 4.74 (0.35) mm for the second position and 4.76 (0.21) mm for the third position. The ONSD measurements of the subjects for the left eye were 4.75 (0.27) mm for the first position, 4.75 (0.16) mm for the second position and 4.76 (0.25) mm for the third position. There was no significant difference in ONSD measurements for either of the eyes in any of the three positions.
Conclusion:
ONSD values measured at the bedside in the supine position were similar to those of the positions obtained with the PLR maneuver in healthy adults.

Project Number

2017-KAEK-189_2019.10.30_20

References

  • 1. Mesquida J, Gruartmoner G, Ferrer R. Passive leg raising for assessment of volume responsiveness: a review. Curr Opin Crit Care. 2017 Jun;23(3):237–43.
  • 2. Beurton A, Teboul J-L, Gavelli F, Gonzalez FA, Girotto V, Galarza L, et al. The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients. Crit Care. 2019 Jan 18;23(1):19.
  • 3. Boulain T, Achard J-M, Teboul J-L, Richard C, Perrotin D, Ginies G. Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients. Chest. 2002 Apr 1;121(4):1245–52.
  • 4. Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015 Jan 14;19(1):18.
  • 5. Thiel SW, Kollef MH, Isakow W. Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care. 2009 Jul 8;13(4):R111.
  • 6. Hariri RJ, Firlick AD, Shepard SR, Cohen DS, Barie PS, Emery JM, et al. Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance. J Neurosurg. 1993 Sep 1;79(3):421–7.
  • 7. Shackford SR. Effect of Small-volume Resuscitation on Intracranial Pressure and Related Cerebral Variables. J Trauma Acute Care Surg. 1997 May;42(5S):48S.
  • 8. Grände P-O, Asgeirsson B, Nordström C-H. Volume-targeted therapy of increased intracranial pressure: the Lund concept unifies surgical and non-surgical treatments. Acta Anaesthesiol Scand. 2002;46(8):929–41.
  • 9. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011 Jul 1;37(7):1059–68.
  • 10. Lochner P, Czosnyka M, Naldi A, Lyros E, Pelosi P, Mathur S, et al. Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci. 2019 Dec 1;40(12):2447–57.
  • 11. Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med. 2017 Jan 1;35(1):150–3.
  • 12. Oswal A, Toma AK. Intracranial pressure and cerebral haemodynamics. Anaesth Intensive Care Med. 2017 May 1;18(5):259–63.
  • 13. Wang AY-C, Hsieh P-C, Chen C-C, Chin S-C, Wu Y-M, Chen C-T, et al. Effect of Intracranial Pressure Control on Improvement of Cerebral Perfusion After Acute Subarachnoid Hemorrhage: A Comparative Angiography Study Based on Temporal Changes of Intracranial Pressure and Systemic Pressure. World Neurosurg. 2018 Dec 1;120:e290–6.
  • 14. Rangel-Castillo L, Gopinath S, Robertson CS. Management of Intracranial Hypertension. Neurol Clin. 2008 May 1;26(2):521–41.
  • 15. Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF, Eisenberg HM, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991 Nov 1;75(Supplement):S59–66.
  • 16. Rossi S, Picetti E, Zoerle T, Carbonara M, Zanier ER, Stocchetti N. Fluid Management in Acute Brain Injury. Curr Neurol Neurosci Rep. 2018 Sep 11;18(11):74.
  • 17. Cooke K, Sharvill R, Sondergaard S, Aneman A. Volume responsiveness assessed by passive leg raising and a fluid challenge: a critical review focused on mean systemic filling pressure. Anaesthesia. 2018;73(3):313–22.
  • 18. Monnet X, Teboul J-L. Passive leg raising. Intensive Care Med. 2008 Apr;34(4):659–63.
  • 19. Jabot J, Teboul J-L, Richard C, Monnet X. Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med. 2009 Jan;35(1):85–90.
  • 20. Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun ŞT, Yıldırım G. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med. 2017 Nov;35(11):1607–11.
  • 21. Wang L, Chen L, Chen Y, Bao L, Zheng N, Wang Y, et al. Ultrasonography Assessments of Optic Nerve Sheath Diameter as a Noninvasive and Dynamic Method of Detecting Changes in Intracranial Pressure. JAMA Ophthalmol. 2018 Mar 1;136(3):250–6.
  • 22. Wang L, Yao Y, Feng L, Wang Y, Zheng N, Feng J, et al. Noninvasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter. Sci Rep. 2017 Feb 7;7(1):42063.
Year 2021, Volume: 3 Issue: 1, 29 - 32, 15.04.2021

Abstract

Supporting Institution

yok

Project Number

2017-KAEK-189_2019.10.30_20

References

  • 1. Mesquida J, Gruartmoner G, Ferrer R. Passive leg raising for assessment of volume responsiveness: a review. Curr Opin Crit Care. 2017 Jun;23(3):237–43.
  • 2. Beurton A, Teboul J-L, Gavelli F, Gonzalez FA, Girotto V, Galarza L, et al. The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients. Crit Care. 2019 Jan 18;23(1):19.
  • 3. Boulain T, Achard J-M, Teboul J-L, Richard C, Perrotin D, Ginies G. Changes in BP Induced by Passive Leg Raising Predict Response to Fluid Loading in Critically Ill Patients. Chest. 2002 Apr 1;121(4):1245–52.
  • 4. Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015 Jan 14;19(1):18.
  • 5. Thiel SW, Kollef MH, Isakow W. Non-invasive stroke volume measurement and passive leg raising predict volume responsiveness in medical ICU patients: an observational cohort study. Crit Care. 2009 Jul 8;13(4):R111.
  • 6. Hariri RJ, Firlick AD, Shepard SR, Cohen DS, Barie PS, Emery JM, et al. Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance. J Neurosurg. 1993 Sep 1;79(3):421–7.
  • 7. Shackford SR. Effect of Small-volume Resuscitation on Intracranial Pressure and Related Cerebral Variables. J Trauma Acute Care Surg. 1997 May;42(5S):48S.
  • 8. Grände P-O, Asgeirsson B, Nordström C-H. Volume-targeted therapy of increased intracranial pressure: the Lund concept unifies surgical and non-surgical treatments. Acta Anaesthesiol Scand. 2002;46(8):929–41.
  • 9. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011 Jul 1;37(7):1059–68.
  • 10. Lochner P, Czosnyka M, Naldi A, Lyros E, Pelosi P, Mathur S, et al. Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci. 2019 Dec 1;40(12):2447–57.
  • 11. Raffiz M, Abdullah JM. Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients. Am J Emerg Med. 2017 Jan 1;35(1):150–3.
  • 12. Oswal A, Toma AK. Intracranial pressure and cerebral haemodynamics. Anaesth Intensive Care Med. 2017 May 1;18(5):259–63.
  • 13. Wang AY-C, Hsieh P-C, Chen C-C, Chin S-C, Wu Y-M, Chen C-T, et al. Effect of Intracranial Pressure Control on Improvement of Cerebral Perfusion After Acute Subarachnoid Hemorrhage: A Comparative Angiography Study Based on Temporal Changes of Intracranial Pressure and Systemic Pressure. World Neurosurg. 2018 Dec 1;120:e290–6.
  • 14. Rangel-Castillo L, Gopinath S, Robertson CS. Management of Intracranial Hypertension. Neurol Clin. 2008 May 1;26(2):521–41.
  • 15. Marmarou A, Anderson RL, Ward JD, Choi SC, Young HF, Eisenberg HM, et al. Impact of ICP instability and hypotension on outcome in patients with severe head trauma. J Neurosurg. 1991 Nov 1;75(Supplement):S59–66.
  • 16. Rossi S, Picetti E, Zoerle T, Carbonara M, Zanier ER, Stocchetti N. Fluid Management in Acute Brain Injury. Curr Neurol Neurosci Rep. 2018 Sep 11;18(11):74.
  • 17. Cooke K, Sharvill R, Sondergaard S, Aneman A. Volume responsiveness assessed by passive leg raising and a fluid challenge: a critical review focused on mean systemic filling pressure. Anaesthesia. 2018;73(3):313–22.
  • 18. Monnet X, Teboul J-L. Passive leg raising. Intensive Care Med. 2008 Apr;34(4):659–63.
  • 19. Jabot J, Teboul J-L, Richard C, Monnet X. Passive leg raising for predicting fluid responsiveness: importance of the postural change. Intensive Care Med. 2009 Jan;35(1):85–90.
  • 20. Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun ŞT, Yıldırım G. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med. 2017 Nov;35(11):1607–11.
  • 21. Wang L, Chen L, Chen Y, Bao L, Zheng N, Wang Y, et al. Ultrasonography Assessments of Optic Nerve Sheath Diameter as a Noninvasive and Dynamic Method of Detecting Changes in Intracranial Pressure. JAMA Ophthalmol. 2018 Mar 1;136(3):250–6.
  • 22. Wang L, Yao Y, Feng L, Wang Y, Zheng N, Feng J, et al. Noninvasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter. Sci Rep. 2017 Feb 7;7(1):42063.
There are 22 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Original Articles
Authors

Emre Gökçen 0000-0002-6018-6105

Dilek Atik 0000-0002-3270-8711

İbrahim Çaltekin 0000-0002-3973-0655

Levent Albayrak 0000-0002-4288-8170

Atakan Savrun 0000-0001-7468-4159

Sevilay Vural 0000-0002-1722-7987

Şeyda Tuba Savrun 0000-0002-6512-2987

Project Number 2017-KAEK-189_2019.10.30_20
Publication Date April 15, 2021
Submission Date February 23, 2021
Acceptance Date February 27, 2021
Published in Issue Year 2021 Volume: 3 Issue: 1

Cite

AMA Gökçen E, Atik D, Çaltekin İ, Albayrak L, Savrun A, Vural S, Savrun ŞT. Does Passive Leg Raising Affect Intracranial Pressure in Healthy Volunteers?. Eurasian j Crit Care. April 2021;3(1):29-32.

Indexing and Abstracting

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