Abstract
Pulse pressure variation can predict fluid responsiveness in strict applicability conditions. The purpose of this study was to describe the clinical applicability of pulse pressure variation during episodes of patient hemodynamic instability in the intensive care unit. We conducted a five-day, seven-center prospective study that included patients presenting with an unstable hemodynamic event. The six predefined inclusion criteria for pulse pressure variation applicability were as follows: mechanical ventilation, tidal volume >7 mL/kg, sinus rhythm, no spontaneous breath, heart rate/respiratory rate ratio >3.6, absence of right ventricular dysfunction, or severe valvulopathy. Seventy-three patients presented at least one unstable hemodynamic event, with a total of 163 unstable hemodynamic events. The six predefined criteria for the applicability of pulse pressure variation were completely present in only 7% of these. This data indicates that PPV should only be used alongside a strong understanding of the relevant physiology and applicability criteria. Although these exclusion criteria appear to be profound, they likely represent an absolute contraindication of use for only a minority of critical care patients.
Highlights
Hemodynamic instability is a common indication for ICU admission and is very likely to occur during a typical ICU stay
Over the five-day inclusion period, 164 patients were screened which corresponded to a total of 487 hospital days
The results demonstrate that only 7% of these unstable hemodynamic events (UHE) strictly meet the pulse pressure variation (PPV) applicability criteria, the majority being patients coming from the operating room
Summary
Hemodynamic instability is a common indication for ICU admission and is very likely to occur during a typical ICU stay. It is well accepted that fluid loading to increase cardiac output (CO) is a major component of appropriate resuscitation [1]. This intervention has been shown to be harmful when hemodynamically unnecessary [2]. It would be extremely valuable to be able to predict an increase in CO before administering fluid. This has been attempted for years using static indices such as central venous pressure (CVP), it is known that these are poorly predictive of a patient’s response to volume expansion [3].
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