Skip to main content
  • Poster presentation
  • Open access
  • Published:

A strong relationship between respiratory variations in pulse pressure (PPV) and airway pressure in fluid nonresponders: a potential explanation for false positive PPV values

Introduction

Respiratory variations in pulse pressure (PPV) during mechanical ventilation predict fluid responsiveness when the tidal volume is >8 ml/kg [1]. The effect of airway pressure on the ability of PPV to predict fluid responsiveness is less explored. In patients undergoing major abdominal surgery, we found low specificity of PPV and therefore explored the relation between peak airway pressure (Paw) and PPV in fluid challenge nonresponders.

Methods

Twenty-five patients scheduled for open abdominal surgery with volume controlled ventilation 8 ml/kg, I:E ratio 1:2 and PEEP 5 cmH2O were included. Fluid challenges of 250 ml colloid were administered at the discretion of the anesthesiologist. PPV, hemodynamic variables, Paw and stroke volume (SV) measured by oesophageal Doppler were recorded before and after fluid challenges. Responders were defined by an increase in SV >15%.

Results

Thirty-four fluid challenges were performed. Further data are from analysis of nonresponders; 12 fluid challenges in 11 patients. Specificity of PPV was 0.67. By fluid challenge, PPV was reduced from 7.4 (6.2 to 15.2)% to 6.0 (4.4 to 9.8)% (median, 25th to 75th percentiles), whereas Paw and SV were unchanged. Before fluid challenge, Paw was significantly correlated with PPV (r = 0.91, P < 0.001) (Figure 1).

Figure 1
figure 1

PPV versus peak airway pressure before fluid challenge in nonresponders.

Conclusions

In this study on patients undergoing open abdominal surgery ventilated with 8 ml/kg, specificity of PPV was low. Paw and PPV were strongly correlated and false positive PPVs were associated with high Paw. This finding indicates that not only tidal volume, but also airway pressures may affect the ability of PPV to predict fluid responsiveness.

References

  1. De Backer , et al.: Intensive Care Med. 2005, 31: 517-523.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article

Hoiseth, L. A strong relationship between respiratory variations in pulse pressure (PPV) and airway pressure in fluid nonresponders: a potential explanation for false positive PPV values. Crit Care 15 (Suppl 1), P52 (2011). https://doi.org/10.1186/cc9472

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc9472

Keywords