The Background of the Problem
Patients who are diagnosed with hypotension typically receive intravenous fluid resuscitation to stabilize the level of water in the body (Kyriakides et al., 1994). It is very important to identify when additional fluid is required since in patients having circulatory failure, fluid replacement is vital for maintaining cardiac functions. Typical clinical parameters are unreliable for measuring the adequacy of the cardiac preload and output (Teboul, Monnet, & Richard, 2005). The problem is aggravated by the fact that fluid overload has been proven to pose a significant threat to patients with blood pressure problems. Thus, the relevance of the research is supported by the necessity to predict fluid responsiveness in such patients to avoid pressure elevation (Rebain, Baxter, & McDonough, 2002). The solution to the problem must reduce fluid administration and improve blood pressure in patients. That is why passive leg raising was selected as an intervention fitting these parameters.
Passive leg raise (PLR) is a maneuver that allows shifting the patient’s blood from the lower body to the intrathoracic compartment, thereby mimicking rapid fluid loading and increasing stroke volume (Ohashi et al., 1997). This test makes it possible to avoid the risks of fluid overload, which is rather safe for patients (Bridges & Jarquin-Valdivia, 2005). Thus, it is logical to assume that passive leg raise can be successfully implemented in clinical settings to predict fluid responsiveness in patients suffering from hypotension and increase their chances for better blood pressure outcomes.
Stakeholders
The primary stakeholders will include patients, nurses, physicians, and health care unit administration. Patients will be involved in the study and provide self-reported information on their condition when the intervention is implemented. Nurses and physicians will be the major change agents responsible for the successful translation of the proposed change to evidence-based practice. Hospital administration will assist in dissemination of the results. Moreover, Joint Commission may also be included on the list of stakeholders since it may provide support in sharing the results with the nursing community.
PICOT Question
The question that the study intends to answer is whether in hypotensive adult patients (P), passive leg raise (I) as compared to no intervention (C) can lead to improved blood pressure outcomes (stabilized blood pressure) (O) during a three-month period of data collection and observation (T).
Study Purpose and Objectives
The purpose of the study is to identify if passive leg raise is an effective method that would allow predicting fluid responsiveness in patients who suffer from circulatory failure and improving their blood pressure outcomes through proper control of fluid levels. The objectives of the study are:
- to identify how much passive leg raising affects stroke volume;
- to study hemodynamic effects that the method produces;
- to assess the patients’ fluid responsiveness by measuring their stroke volume index;
- to provide recommendations as per the implementation of the intervention.
The expected change is to introduce a reliable test that would allow nurses to assess the necessity of intravenous fluid resuscitation and achieve the best outcome for each patient having hypotension.
The Significance of the Problem for Nursing
The issue is especially important for nurses to resolve since it is the nurse who decides whether fluid boluses should be administered to improve hypoperfusion (Pinsky & Payen, 2005). The problem is that less than 50% of all patients respond to this measure by the increase in stroke volume (Mancia et al., 1991). This means that its effectiveness should be predicted in advance to avoid complications caused by fluid overload (Rex et al., 2004). Thus, the results of the study will considerably change the nursing practice, providing nurses with an effective tool allowing them to identify fluid responsiveness and decide what measure will improve the patient’s blood pressure.
References
Bridges, N., & Jarquin-Valdivia, A. A. (2005). Use of the Trendelenburg position as the resuscitation position: To T or not to T? American Journal of Critical Care, 14(5), 364-368.
Kyriakides, Z. S., Koukoulas, A., Paraskevaidis, I. A., Chrysos, D., Tsiapras, D., Galiotos, C., & Kremastinos, D. T. (1994). Does passive leg raising increase cardiac performance? A study using Doppler echocardiography. International Journal of Cardiology, 44(3), 288-293.
Mancia, G., Cleroux, J., Daffonchio, A., Ferrari, A. U., Giannattasio, C., & Grassi, G. (1991). Reflex control of circulation in the elderly. Cardiovascular Drugs and Therapy, 4(1), 1223-1228.
Ohashi, M., Sato, K., Suzuki, S., Kinoshita, M., Miyagawa, K., Kojima, M., & Dohi, Y. (1997). Doppler echocardiographic evaluation of latent pulmonary hypertension by passive leg raising. Coronary Artery Disease, 8(10), 651-656.
Pinsky, M. R., & Payen, D. (2005). Functional hemodynamic monitoring. Critical Care, 9(6), 566-578.
Rebain, R., Baxter, G. D., & McDonough, S. (2002). A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000). Spine, 27(17), E388-E395.
Rex, S., Brose, S., Metzelder, S., Hüneke, R., Schälte, G., Autschbach, R.,… Buhre, W. (2004). Prediction of fluid responsiveness in patients during cardiac surgery. British Journal of Anaesthesia, 93(6), 782-788.
Teboul, J. L., Monnet, X., & Richard, C. (2005). Arterial pulse pressure variation during positive pressure ventilation and passive leg raising. Functional Hemodynamic Monitoring, 3(2), 331-343.