• Joya D Pickett, Elizabeth Bridges, Patricia A Kritek, and JoAnne D Whitney.
• Joya D. Pickett completed her doctoral degree at the University of Washington, School of Nursing, and practices as a critical care clinical nurse specialist at Swedish Medical Center in Seattle, Washington. joyap@u.washington.edu.
• Crit Care Nurse. 2017 Apr 1; 37 (2): 32-47.

AbstractFluid boluses are often administered with the aim of improving tissue hypoperfusion in shock. However, only approximately 50% of patients respond to fluid administration with a clinically significant increase in stroke volume. Fluid overload can exacerbate pulmonary edema, precipitate respiratory failure, and prolong mechanical ventilation. Therefore, it is important to predict which hemodynamically unstable patients will increase their stroke volume in response to fluid administration, thereby avoiding deleterious effects. Passive leg-raising (lowering the head and upper torso from a 45° angle to lying supine [flat] while simultaneously raising the legs to a 45° angle) is a transient, reversible autotransfusion that simulates a fluid bolus and is performed to predict a response to fluid administration. The article reviews the accuracy, physiological effects, and factors affecting the response to passive-leg raising to predict fluid responsiveness in critically ill patients.©2017 American Association of Critical-Care Nurses.

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