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Long live dynamic parameters!

Critical Care201418:413

https://doi.org/10.1186/cc13749

  • Published:

Keywords

  • Vital Sign
  • Oxygen Saturation
  • Medical Device
  • Dynamic Parameter
  • Arterial Oxygen

In a recent article about pulse pressure variation (PPV), after 4 pages of physiologic explanations, Dr Sondergaard finally concluded that 'the subject is an exceptional demonstration of physiology but hardly guides the management of critically ill patients’ [1]. If I agree with the first part of this statement (I and others spent years dissecting the complex physiology behind PPV), I strongly disagree with the second part of the sentence for three reasons, which are not opinions but facts.

First, PPV and stroke volume variation (SVV) are increasingly used to guide fluid therapy both in the operating theater and in ICUs. This was confirmed by published peer-reviewed surveys, showing that the use of dynamic parameters increased from 1% in 1998 [2] to 45% in 2012 [3]. If dynamic parameters were not clinically useful one can doubt clinicians would have embraced this concept as they did.

Second, PPV and SVV are today displayed on almost all bedside and hemodynamic monitors, next to other vital signs such as the heart rate, blood pressure and arterial oxygen saturation. If medical device industry has financial interests in doing this, it is not fool enough to make research and development investments on something caregivers do not value in their clinical practice.

Third, at least 10 randomized controlled trials have demonstrated that hemodynamic strategies based on PPV or SVV monitoring allow a significant reduction in post-surgical complications and hospital length of stay (Table 1).
Table 1

Randomized controlled trials demonstrating the ability of hemodynamic strategies based on pulse pressure variation or stroke volume variation monitoring to improve postsurgical outcome

Study

Surgical population

Hemodynamic goal

Clinical benefit

Benes and colleagues, 2010 [4]

Major abdominal

SVV <10 %

Decrease in complications and hospital length of stay

Goepfert and colleagues, 2013 [5]

Cardiac

SVV <10 %

Decrease in complications and ICU length of stay

Lopes and colleagues, 2007 [6]

Major abdominal

PPV <10 %

Decrease in complications and ICU and hospital length of stay

Mayer and colleagues, 2010 [7]

Major abdominal

SVV <12 %

Decrease in complications and hospital length of stay

Ramsingh and colleagues, 2013 [8]

Major abdominal

SVV <12 %

Faster return of gastrointestinal function and decrease in hospital length of stay

Salzwedel and colleagues, 2013 [9]

Major abdominal

PPV <10 %

Decrease in complications

Schereen and colleagues, 2013 [10]

Major abdominal

SVV <10 %

Decrease in surgical site infections

Zhang and colleagues, 2012 [11]

Major abdominal

PPV <11 %

Faster return of gastrointestinal function and decrease in hospital length of stay

Zhang and colleagues, 2013 [12]

Thoracic

SVV = 10 %

Decrease in complications and intubation time

Zheng and colleagues, 2013 [13]

Major abdominal

SVV <12 %

Faster return of gastrointestinal function and decrease in ICU and hospital length of stay

PPV, pulse pressure variation; SVV, stroke volume variation.

So dynamic parameters are well alive and useful for improving patient outcome. Long live dynamic parameters!

Abbreviations

PPV: 

Pulse pressure variation

SVV: 

Stroke volume variation.

Declarations

Authors’ Affiliations

(1)
Edwards Lifesciences, 1 Edwards Way, Irvine, CA 92614, USA

References

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  2. Boldt J, Lenz M, Kumle B, Papsdorf M: Volume replacement strategies on intensive care units: results from a postal survey. Intensive Care Med 1998, 24: 147-151. 10.1007/s001340050536View ArticlePubMedGoogle Scholar
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Copyright

© BioMed Central Ltd. 2014

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