The Changes in Pulse Pressure Variation or Stroke Volume Variation After a “Tidal Volume Challenge” Reliably Predict Fluid Responsiveness During Low Tidal Volume Ventilation*

Abstract

The changes in pulse pressure variation or stroke volume variation obtained by transiently increasing tidal volume (tidal volume challenge) are superior to pulse pressure variation and stroke volume variation in predicting fluid responsiveness during low tidal volume ventilation.

Use of ‘tidal volume challenge’ to improve the reliability of pulse pressure variation

“…The tidal volume challenge thus improved the reliability of PPV in predicting fluid responsiveness in patients receiving low tidal volume ventilation. Similar results were also seen using SVV (∆SVV 6–8 ) obtained from a pulse contour analysis cardiac output device with an AUROC of 0.97 (sensitivity 88% and specificity 100%) with a cut off value of 2.5% [45]. The change in PPV after giving a fluid bolus (∆PPV fb ) also accurately confirmed fluid responsiveness with an AUROC of 0.98 (sensitivity 94% and specificity 100%) with a cut off value of 1.5%.…”

“…The ‘tidal volume challenge’ is a novel test proposed to improve the reliability of PPV during low tidal volume ventilation [45]. The test involves transiently increasing tidal volume from 6 ml/kg PBW to 8 ml/kg PBW for one minute and observing the change in PPV (∆PPV 6–8 ) from baseline (PPV 6 ) to that at 8 ml/kg PBW (PPV 8 ).…”

“…The test involves transiently increasing tidal volume from 6 ml/kg PBW to 8 ml/kg PBW for one minute and observing the change in PPV (∆PPV 6–8 ) from baseline (PPV 6 ) to that at 8 ml/kg PBW (PPV 8 ). In a recent study testing the tidal volume challenge [45], 30 sets of measurements were recorded in 20 patients with acute circulatory failure receiving low tidal volume ventilation using volume assist‐control ventilation and without spontaneous breathing activity. Fluid responsiveness was defined as an increase in thermodilution cardiac output > 15% after giving a fluid bolus after reducing tidal volume back to 6 m/kg PBW.…”

“…Importantly, there was a significant increase in PPV (∆PPV 6–8 ), following the tidal volume challenge only in fluid responders. The ∆PPV 6–8 discriminated responders from non‐responders with an AUROC of 0.99 (sensitivity 94% and specificity 100%) with a cut off value of 3.5% [45]. The tidal volume challenge thus improved the reliability of PPV in predicting fluid responsiveness in patients receiving low tidal volume ventilation.…”

Utility of electrical velocimetry‐based noninvasive stroke volume variation in predicting fluid responsiveness under different ventilation modes in anaesthetized dogs

“…It has been used as a dynamic preload predictor of fluid responsiveness in mechanically ventilated patients. 1,2 A noninvasive haemodynamic monitoring system, without the need for calibration, using the electrical velocimetry (EV) method has been described in dogs undergoing experimental cardiac surgery. 3 This study evaluated the performance of EV-derived continuous cardiac output (CO) and the dynamic preload indicator SVV as comparable to the Swan-Ganz pulmonary thermodilution technique during assist control (A/C) ventilation throughout the study.…”