Passive Leg Raise Maneuver

Aka: Passive Leg Raise Maneuver, PLR Maneuver

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II. Indications

  1. Hypotension or shock evaluation
    1. Predict volume responsiveness (that Hypotension will respond to fluid bolus)
    2. Reversible fluid challenge

III. Mechanism

  1. Adult lower extremity veins contain 150-200 ml blood per leg
  2. Elevation of both legs above the heart provides a transient autologous fluid bolus of 300-400 cc

IV. Technique: Passive Leg Raise (PLR)

  1. Start with patient in semirecumbent position (sitting up)
    1. Head of bed elevated 45 degrees and legs flat
  2. Measure hemodynamic parameters obtained
    1. See Inferior Vena Cava Ultrasound for Volume Status
    2. See Stroke Volume Estimation by Bedside Ultrasound
    3. Obtain Blood Pressure and Heart Rate
    4. Arterial Line or other non-invasive hemodynamic monitoring parameters as available
      1. End-Tidal CO2 (EtCO2) may be used in intubated patients
  3. Reposition patient with both legs elevated
    1. Head of bed at 0 degrees flat and both legs elevated to 45 degrees
  4. Wait for 60-90 seconds
    1. Repeat hemodynamic parameter measurements as above

V. Interpretation

  1. Significant improvement in hemodynamic parameters following leg elevation suggests volume responsiveness
  2. Stroke Volume (LVOT VTI) increase of 10-15% with leg raise suggests fluid responsiveness
  3. End-Tidal CO2 (EtCO2) increase of 2 mmHg or 5% is suggestive of fluid responsiveness in intubated patients

VI. References

  1. Swaminathan and Mallemat (2026) Passive Leg Raise, EM:Rap, accessed 6/6/2026

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