Pavane for a pulse pressure variation defunct

Abstract

Hemodynamic management of critically ill patients in the ICU or high-risk patients in the operating room has paradoxically shown progress in terms of outcome after the systematic application of volume responsiveness/flow optimization based on pulse pressure variation and/or stroke volume variation during controlled, positive-pressure ventilation in patients without spontaneous respiratory efforts. This assessment of circulatory optimization should ideally be based on an exhaustive, predictive and coherent physiological understanding of the cardiovascular system model. This paper sketches the extremely complex physiological background of the concept of volume responsiveness, concluding that it is not a reliable means of guiding hemodynamic optimization because it is based on a nonexhaustive, nonpredictive and incoherent physiological model.

Arterial pulse pressure variation suitability in critical care: A French national survey

“…These confounding factors were frequently observed in the study and could explain why isolated PPV must be used with caution by physicians when predicting fluid responsiveness. Interestingly, Sondergaard et al [19] suggest using a checklist before performing volume expansion when predicted by PPV. Other alternatives have been described to predict fluid responsiveness, such as the passive leg raising test [20], the variability of inferior vena cava diameter, the mini-fluid challenge [21], or the end-expiratory occlusion test [8].…”

Ventilator‐induced central venous pressure variation can predict fluid responsiveness in post‐operative cardiac surgery patients

“…First, 22 controlled mechanically ventilated cardiac surgery patients with a regular heart rhythm were studied, so the results of this pilot study are certainly not generalizable to all ICU patients. 20 Only 14% of patients in our study were classified as fluid non-responders, with the vast majority of patients requiring vasoactive medication. 8,25 Baseline CVP was higher in fluid non-responders, possibly indicating the presence of right ventricular dysfunction, compared to fluid responders.…”

Is internal jugular vein extensibility associated with indices of fluid responsiveness in ventilated patients?

“…22 Despite our taking into account these caveats and the fact that PPV should reflect volume responsiveness with sufficient accuracy, we wish to stress that dynamic indices can reflect the patient's condition only in their own restricted scale. Its validity is lessened when fundamental conditions are ignored.…”

“…The mean HR/RR ratio was ≥3.6. 22 Using these ventilation parameters, a threshold value of ≥12% PPV was demonstrated to be predictive of fluid responsiveness. 17 PPV values we measured were comparable with what Suzuki et al reported for patients after cardiac surgery when evaluating PPV to guide post-operative fluid therapy.…”