Monday, January 15, 2018

PPV and fluid responsiveness

Q: Recent literature has shown that pulse pressure variation (PPV) is a better indicator of fluid responsiveness than central venous pressure (CVP). But applicability of PPV  is limited. Which conditions should be met to obtain reliable PPV?


1. Patient should be mechanically ventilated
2. Patient should not be spontaneously triggering the ventilator
3. Tidal Volume (TV) on ventilator should be  ≥8 mL/kg of ideal body weight
4. Patient should be in normal sinus rhythm
5. Patient has no major alternations to chest wall compliance (making open chest patients ineligible) 

PPV of 12 -15 percent is usually associated with volume responsiveness.

References/further reading:

1. Pinsky MR. Functional haemodynamic monitoring. Curr Opin Crit Care 2014; 20:288.

2. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37(9):2642-7

3. Michard F, Teboul JL. Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002; 121:2000.

4. Michard F, Boussat S, Chemla D, et al. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000; 162:134.

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