A 70-year-old man with ischemic heart disease is admitted to ICU post-laparotomy for perforated duodenal ulcer. He has received 3 litres of crystalloid. Central venous pressure is 4 mmHg, MAP is 62 mmHg, and lactate is 4.8 mmol/L. A passive leg raise test shows a 15% increase in stroke volume. What does this finding indicate?
- A The patient has reached the flat portion of the Frank-Starling curve
- B The patient is fluid responsive and will likely benefit from further fluid bolus ✓
- C The patient requires immediate norepinephrine without further fluids
- D The patient has cardiogenic shock requiring inotropic support
Correct answer: B. The patient is fluid responsive and will likely benefit from further fluid bolus
Explanation
A passive leg raise (PLR) test that increases stroke volume by ≥10% indicates fluid responsiveness, meaning the patient is on the steep portion of the Frank-Starling curve. A 15% increase reliably predicts that additional crystalloid will improve cardiac output. This is a dynamic assessment superior to static measures like CVP alone for guiding fluid therapy in critically ill patients.
Reference: Miller's Anesthesia, 9th ed.
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Written and medically reviewed by the StethoPrep medical team.