Open Access Open Access  Restricted Access Subscription Access

Applicability of Pulse Pressure Variation during Unstable Hemodynamic Events in the Intensive Care Unit: a Five-Day Prospective Multicenter Study


Affiliations
1 Service de Reanimation Medicale, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
2 Service de Reanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Benite, France
3 Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
4 Department of Anesthesiology and Critical Care Medicine, Pavilion P, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
5 Intensive Care Unit, Centre Hospitalier de Roanne, 42300 Roanne, France
6 Unite de Reanimation Chirurgicale, Hospices Civils de Lyon, Hopital de la Croix-Rousse, Universite de Lyon, 69004 Lyon, France
7 Department of Anesthesiology & Perioperative Care, School of Medicine, University of California, Irvine, Orange, CA 92868, United States
8 Department of Anesthesiology and Intensive Care, Clinique de la Sauvegarde, 69009 Lyon, France
 

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.
User
Notifications
Font Size

Abstract Views: 67

PDF Views: 0




  • Applicability of Pulse Pressure Variation during Unstable Hemodynamic Events in the Intensive Care Unit: a Five-Day Prospective Multicenter Study

Abstract Views: 67  |  PDF Views: 0

Authors

Bertrand Delannoy
Service de Reanimation Medicale, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
Florent Wallet
Service de Reanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Benite, France
Delphine Maucort-Boulch
Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
Mathieu Page
Department of Anesthesiology and Critical Care Medicine, Pavilion P, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France
Mahmoud Kaaki
Intensive Care Unit, Centre Hospitalier de Roanne, 42300 Roanne, France
Mathieu Schoeffler
Unite de Reanimation Chirurgicale, Hospices Civils de Lyon, Hopital de la Croix-Rousse, Universite de Lyon, 69004 Lyon, France
Brenton Alexander
Department of Anesthesiology & Perioperative Care, School of Medicine, University of California, Irvine, Orange, CA 92868, United States
Olivier Desebbe
Department of Anesthesiology and Intensive Care, Clinique de la Sauvegarde, 69009 Lyon, France

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.