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The value of pulse pressure variation to predict volume response in patients ventilated with low VT
Critical Care volume 14, Article number: P116 (2010)
The prediction value of pulse pressure variation (ΔPP) in patients ventilated with low VT is not well studied. A ΔPP of 12 to 13% is validated as a predictor of volume response in several studies, but in patients ventilated with VT >8 ml/kg. One study has shown that the ΔPP of 12 to 13% does not predict volume response in patients ventilated with a low VT. We hypothesized that a lower cut-off value for ΔPP can predict volume response in patients with low VT.
Thirty-seven adult patients mechanically ventilated with a tidal volume <8 ml/kg (PBW), without cardiac arrhythmias, with a pulmonary artery catheter and a peripheral arterial catheter were included. An increase in cardiac index (thermodilution)) >15% output after a fluid challenge (Crystalloid 1,000 ml or Colloid 500 ml) was considered a positive response.
Seventeen patients were responders. The ROC curve showed that the best cut-off value for ΔPP was 10% (ROC area = 0.74, 95% CI: 0.51 to 0.9; sensitivity 53%, specificity 95%, positive likelihood ratio 9.4 and negative 0.34). Twelve patients consisted of a heterogeneous group of patients (liver transplant, acute pancreatitis, aortic surgery). Among 25 septic shock patients, a ΔPP >10% showed a ROC area of 0.84 (sensitivity 78%, specificity 93%). In any case, the greater ΔPP, the greater the fluid response. ΔPP >10% was a better predictor than CVP or PAOP.
ΔPP has a limited value in patients ventilated with low VT. However, a ΔPP >10% may help identify septic shock patients that will respond to a fluid challenge.
Vincent JL, et al: Pulse pressure variations to predict fluid responsiveness: Influence of tidal volume. Intensive Care Med. 2005, 31: 517-523. 10.1007/s00134-005-2586-4.
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Friedman, G., Costa, C., Vieira, S. et al. The value of pulse pressure variation to predict volume response in patients ventilated with low VT. Crit Care 14, P116 (2010). https://doi.org/10.1186/cc8348
- Liver Transplant
- Acute Pancreatitis
- Tidal Volume