---
title: "Passive leg raise using ETCO2 to predict fluid responsiveness in ED sepsis patients"
id: "pubmed-42765758"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42765758"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42765758/"
doi: "10.1097/NSG.0000000000000468"
published_at: "2026-09-21T17:35:15.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Passive leg raise using ETCO2 to predict fluid responsiveness in ED sepsis patients
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42765758
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42765758/)
- **DOI:** [10.1097/NSG.0000000000000468](https://doi.org/10.1097%2FNSG.0000000000000468)
- **Published At:** 2026-09-21T17:35:15.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Background: Sepsis-related hypotension is commonly treated with intravenous fluids, but excess fluids can cause pulmonary edema and respiratory failure. A noninvasive bedside test that helps predict who will respond to fluids could reduce harm. - Intervention tested: Use of **passive leg raise (PLR)** combined with monitoring of **end-tidal carbon dioxide (ETCO2)** as a noninvasive method to evaluate **fluid responsiveness** in emergency department (ED) patients with sepsis, including both spontaneously breathing and intubated patients. - Objective: Determine the effectiveness of PLR with ETCO2 monitoring after initial fluid resuscitation among patients with sepsis. - Design: Quantitative comparative cohort study comparing a retrospective preintervention cohort (n = 259) who did not receive PLR versus a prospective intervention cohort (n = 77) who received PLR. The intervention cohort was further analyzed by responsiveness status (responders n = 28; nonresponders n = 49). - Key findings: The PLR group received a higher total fluid volume than the preintervention group (P < .001). Tachycardia was more common in the preintervention cohort than in the intervention cohort (P < .001). - Within the PLR cohort, 64% were identified as negative **fluid responders** by ETCO2/PLR. These nonresponders had a lower mean total fluid administration than responders, but this difference did not reach statistical significance (P = .06). - Interpretation: The study authors conclude that PLR with ETCO2 monitoring can be instrumental in assessing fluid responsiveness among ED sepsis patients who are spontaneously breathing or mechanically ventilated. - Limitations / missing details in the source: Specific thresholds used to define ETCO2 change for fluid responsiveness, exact timing of PLR relative to initial resuscitation, and other protocol specifics were not reported in the abstract on PubMed and therefore are not available here.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 21. # Passive leg raise as a noninvasive nursing intervention to predetermine fluid responsiveness in patients with sepsis in the emergency department: A comparative cohort study [Janet Gregory](https://pubmed.ncbi.nlm.nih.gov/?term=Gregory+J&cauthor_id=42765758)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765758/#full-view-affiliation-1 "Janet Gregory is Manager of Clinical Education and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Catherine Restua is a Nephrology Nurse Practitioner at Renal Specialists of Houston, Pearland, TX. Marie Baumann and Mary Ann Esquela are Registered Nurses in the Emergency Department at Memorial Hermann Pearland Hospital, Pearland, TX. Laura Gobeli is Director of System Policies, Procedures, Guidelines, & Clinical Forms at Memorial Hermann Health System, Houston, TX. Vicki Harbeck is a Specialist, Clinical Education and Professional Development at Memorial Hermann Southeast Hospital, Houston, TX. Lowine Sarbacker, now retired, was the former Director of Clinical and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Gregg Shoemaker is Director of Emergency Services at Memorial Hermann Pearland Hospital, Pearland, TX. Tu Sibert is a Registered Nurse, Critical Care, Memorial Hermann Southeast Hospital, Houston, TX. Charles Wellington is a Registered Nurse, Critical Care, Memorial Hermann Pearland Hospital, Pearland, TX. Shameya Ceasar is Vice President and Chief Nurse Officer at Memorial Hermann Pearland Hospital, Pearland, TX. Tajudaullah Bhaloo and Jessica Peterson are Scientists at the Institute for Nursing Excellence, Memorial Hermann Health System in Houston, TX."), [Catherine Restua](https://pubmed.ncbi.nlm.nih.gov/?term=Restua+C&cauthor_id=42765758), [Marie Baumann](https://pubmed.ncbi.nlm.nih.gov/?term=Baumann+M&cauthor_id=42765758), [Mary Ann Esquela](https://pubmed.ncbi.nlm.nih.gov/?term=Esquela+MA&cauthor_id=42765758), [Laura Gobeli](https://pubmed.ncbi.nlm.nih.gov/?term=Gobeli+L&cauthor_id=42765758), [Vicki Harbeck](https://pubmed.ncbi.nlm.nih.gov/?term=Harbeck+V&cauthor_id=42765758), [Lowine Sarbacker](https://pubmed.ncbi.nlm.nih.gov/?term=Sarbacker+L&cauthor_id=42765758), [Gregg Shoemaker](https://pubmed.ncbi.nlm.nih.gov/?term=Shoemaker+G&cauthor_id=42765758), [Tu Sibert](https://pubmed.ncbi.nlm.nih.gov/?term=Sibert+T&cauthor_id=42765758), [Charles Wellington](https://pubmed.ncbi.nlm.nih.gov/?term=Wellington+C&cauthor_id=42765758), [Shameya Ceasar](https://pubmed.ncbi.nlm.nih.gov/?term=Ceasar+S&cauthor_id=42765758), [Jessica Peterson](https://pubmed.ncbi.nlm.nih.gov/?term=Peterson+J&cauthor_id=42765758), [Tajudaullah Bhaloo](https://pubmed.ncbi.nlm.nih.gov/?term=Bhaloo+T&cauthor_id=42765758) Affiliations Expand ### Affiliation * 1 Janet Gregory is Manager of Clinical Education and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Catherine Restua is a Nephrology Nurse Practitioner at Renal Specialists of Houston, Pearland, TX. Marie Baumann and Mary Ann Esquela are Registered Nurses in the Emergency Department at Memorial Hermann Pearland Hospital, Pearland, TX. Laura Gobeli is Director of System Policies, Procedures, Guidelines, & Clinical Forms at Memorial Hermann Health System, Houston, TX. Vicki Harbeck is a Specialist, Clinical Education and Professional Development at Memorial Hermann Southeast Hospital, Houston, TX. Lowine Sarbacker, now retired, was the former Director of Clinical and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Gregg Shoemaker is Director of Emergency Services at Memorial Hermann Pearland Hospital, Pearland, TX. Tu Sibert is a Registered Nurse, Critical Care, Memorial Hermann Southeast Hospital, Houston, TX. Charles Wellington is a Registered Nurse, Critical Care, Memorial Hermann Pearland Hospital, Pearland, TX. Shameya Ceasar is Vice President and Chief Nurse Officer at Memorial Hermann Pearland Hospital, Pearland, TX. Tajudaullah Bhaloo and Jessica Peterson are Scientists at the Institute for Nursing Excellence, Memorial Hermann Health System in Houston, TX. * PMID: **42765758** * DOI: [ 10.1097/NSG.0000000000000468 ](https://doi.org/10.1097/nsg.0000000000000468) Item in Clipboard Comparative Study # Passive leg raise as a noninvasive nursing intervention to predetermine fluid responsiveness in patients with sepsis in the emergency department: A comparative cohort study Janet Gregory et al. Nursing. 2026. Show details Display options Display options Format Abstract PubMed PMID Nursing Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Nursing%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Nursing%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) . 2026 Oct 1;56(10):46-53. doi: 10.1097/NSG.0000000000000468. Epub 2026 Sep 21. ### Authors [Janet Gregory](https://pubmed.ncbi.nlm.nih.gov/?term=Gregory+J&cauthor_id=42765758)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765758/#short-view-affiliation-1 "Janet Gregory is Manager of Clinical Education and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Catherine Restua is a Nephrology Nurse Practitioner at Renal Specialists of Houston, Pearland, TX. Marie Baumann and Mary Ann Esquela are Registered Nurses in the Emergency Department at Memorial Hermann Pearland Hospital, Pearland, TX. Laura Gobeli is Director of System Policies, Procedures, Guidelines, & Clinical Forms at Memorial Hermann Health System, Houston, TX. Vicki Harbeck is a Specialist, Clinical Education and Professional Development at Memorial Hermann Southeast Hospital, Houston, TX. Lowine Sarbacker, now retired, was the former Director of Clinical and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Gregg Shoemaker is Director of Emergency Services at Memorial Hermann Pearland Hospital, Pearland, TX. Tu Sibert is a Registered Nurse, Critical Care, Memorial Hermann Southeast Hospital, Houston, TX. Charles Wellington is a Registered Nurse, Critical Care, Memorial Hermann Pearland Hospital, Pearland, TX. Shameya Ceasar is Vice President and Chief Nurse Officer at Memorial Hermann Pearland Hospital, Pearland, TX. Tajudaullah Bhaloo and Jessica Peterson are Scientists at the Institute for Nursing Excellence, Memorial Hermann Health System in Houston, TX."), [Catherine Restua](https://pubmed.ncbi.nlm.nih.gov/?term=Restua+C&cauthor_id=42765758), [Marie Baumann](https://pubmed.ncbi.nlm.nih.gov/?term=Baumann+M&cauthor_id=42765758), [Mary Ann Esquela](https://pubmed.ncbi.nlm.nih.gov/?term=Esquela+MA&cauthor_id=42765758), [Laura Gobeli](https://pubmed.ncbi.nlm.nih.gov/?term=Gobeli+L&cauthor_id=42765758), [Vicki Harbeck](https://pubmed.ncbi.nlm.nih.gov/?term=Harbeck+V&cauthor_id=42765758), [Lowine Sarbacker](https://pubmed.ncbi.nlm.nih.gov/?term=Sarbacker+L&cauthor_id=42765758), [Gregg Shoemaker](https://pubmed.ncbi.nlm.nih.gov/?term=Shoemaker+G&cauthor_id=42765758), [Tu Sibert](https://pubmed.ncbi.nlm.nih.gov/?term=Sibert+T&cauthor_id=42765758), [Charles Wellington](https://pubmed.ncbi.nlm.nih.gov/?term=Wellington+C&cauthor_id=42765758), [Shameya Ceasar](https://pubmed.ncbi.nlm.nih.gov/?term=Ceasar+S&cauthor_id=42765758), [Jessica Peterson](https://pubmed.ncbi.nlm.nih.gov/?term=Peterson+J&cauthor_id=42765758), [Tajudaullah Bhaloo](https://pubmed.ncbi.nlm.nih.gov/?term=Bhaloo+T&cauthor_id=42765758) ### Affiliation * 1 Janet Gregory is Manager of Clinical Education and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Catherine Restua is a Nephrology Nurse Practitioner at Renal Specialists of Houston, Pearland, TX. Marie Baumann and Mary Ann Esquela are Registered Nurses in the Emergency Department at Memorial Hermann Pearland Hospital, Pearland, TX. Laura Gobeli is Director of System Policies, Procedures, Guidelines, & Clinical Forms at Memorial Hermann Health System, Houston, TX. Vicki Harbeck is a Specialist, Clinical Education and Professional Development at Memorial Hermann Southeast Hospital, Houston, TX. Lowine Sarbacker, now retired, was the former Director of Clinical and Professional Development at Memorial Hermann Southeast and Pearland Hospitals, Houston, TX. Gregg Shoemaker is Director of Emergency Services at Memorial Hermann Pearland Hospital, Pearland, TX. Tu Sibert is a Registered Nurse, Critical Care, Memorial Hermann Southeast Hospital, Houston, TX. Charles Wellington is a Registered Nurse, Critical Care, Memorial Hermann Pearland Hospital, Pearland, TX. Shameya Ceasar is Vice President and Chief Nurse Officer at Memorial Hermann Pearland Hospital, Pearland, TX. Tajudaullah Bhaloo and Jessica Peterson are Scientists at the Institute for Nursing Excellence, Memorial Hermann Health System in Houston, TX. * PMID: **42765758** * DOI: [ 10.1097/NSG.0000000000000468 ](https://doi.org/10.1097/nsg.0000000000000468) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Sepsis-related hypotension is treated by administration of intravenous fluids. Excess fluid volume can result in pulmonary edema and respiratory failure. Monitoring increases in patients' end-tidal carbon dioxide (ETCO2) in response to a passive leg raise (PLR) is a noninvasive method to evaluate fluid responsiveness. **Objective:** To determine the effectiveness of PLR and ETCO2 monitoring after initial fluid resuscitation among spontaneously breathing or intubated patients with sepsis. **Methods:** Using a quantitative comparative design, the study compared the total amount of fluid administered and outcomes between two cohorts of patients with sepsis in the emergency department (ED): the preintervention retrospective cohort (n = 259) who did not receive PLR, and the intervention prospective sample (n = 77) who received the PLR intervention. Supplementary analyses divided the intervention group into those who did (n = 28) and did not (n = 49) meet criteria for fluid responsiveness, comparing fluid administration totals. **Results:** Patients who received PLR had a higher total fluid volume administered than the preintervention group (P < .001). Tachycardia was more common in the preintervention group than in the intervention group (P < .001). Of the patients who received PLR, 64% were identified as negative fluid responders. These patients had lower mean total fluid administration, although the difference was not statistically significant (P = .06). **Conclusion:** This study demonstrates that PLR can be instrumental in assessing fluid responsiveness among ED patients with sepsis who are spontaneously breathing or intubated. **Keywords:** end-tidal carbon dioxide; fluid responsiveness; mechanically ventilated; passive leg raise; sepsis. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## References 1. 1. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: the evolution in definition, pathophysiology, and management. SAGE Open Med. 2019;7:1–13. 2. 1. Surviving Sepsis Campaign (SSC). Surviving Sepsis Campaign. 2025. Accessed May 5, 2026. [www.sccm.org/SurvivingSepsisCampaign](http://www.sccm.org/SurvivingSepsisCampaign) 3. 1. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247. 4. 1. Alvarado Sánchez JI, Caicedo Ruiz JD, Diaztagle Fernández JJ, Amaya Zuñiga WF, Ospina-Tascón GA, Cruz Martínez LE. Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis. Ann Intensive Care. 2021;11(1):28. 5. 1. Monnet X, Teboul J-L. Passive leg raising: five rules, not a drop of fluid! Crit Care. 2015;19(1):18. Show all 21 references ## Publication types * Comparative Study Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Comparative+Study%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Comparative+Study) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) ## MeSH terms * Aged Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Aged%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Aged) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) * Cohort Studies Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cohort+Studies%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Cohort+Studies) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) * Emergency Service, Hospital / organization & administration Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Emergency+Service%2C+Hospital%2Forganization+and+administration%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Emergency+Service%2C+Hospital) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) * Female Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Female%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Female) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) * Fluid Therapy* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Fluid+Therapy%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Fluid+Therapy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765758/) * Fluid Therapy* / nursing Actions
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