Key result
Pulse pressure variation ≥13% was present in 19% of measurements among non-cardiac critically ill patients and significantly correlated with CVP (P=0.04), HR (P<0.001), and peak airway pressure (P=0.001).
Why the study?
What is the prevalence and hemodynamic associations of a pulse pressure variation ≥ 13% among non-cardiac critically ill patients?
Observational (n=37)
No
What is the prevalence and hemodynamic associations of a pulse pressure variation ≥ 13% among non-cardiac critically ill patients?
In non-cardiac critically ill patients, a fluid-responsive pulse pressure variation (≥ 13%) is present in about one-fifth of measurements and correlates with key hemodynamic and ventilation variables.
Caution advised interpreting PPV ≥13% for fluid responsiveness in non-cardiac ICU patients; hypothesis-generating given observational design and confounding associations.
BACKGROUND: A pulse pressure variation (PPV) ≥ 13% of mean arterial pressure (MAP) is an accepted marker of a fluid-responsive state. However, there is no study of its epidemiology and associations among non-cardiac critically ill patients. OBJECTIVES: To conduct a pilot study of the epidemiology and associations of a PPV ≥ 13% among non-cardiac critically ill patients. DESIGN: Prospective observational study. SETTING: Intensive care unit of a university hospital. PATIENTS: Cohort of 37 sedated critically ill patients undergoing mandatory ventilation. MAIN OUTCOME MEASURES: PPV values, tidal volume and peak airway pressure, MAP, heart rate (HR) and central venous pressure (CVP) collected every 15 minutes; fluid balance collected hourly; correlation between PPV and these variables. RESULTS: 450 PPV measurements were collated. The PPV value was ≥ 13% in 86 (19%) measurements and was observed in two consecutive measurements in 68 (15%) of cases. On multivariable analysis, mean PPV was significantly correlated with CVP (P=0.04), HR (P<0.001) and peak airway pressure (P=0.001), but not fluid balance (P=0.3). CONCLUSIONS: Among non-cardiac surgery mechanically ventilated patients, a PPV in the fluid-responsive range was present in one-fifth of measurements and showed logical correlations with relevant haemodynamic and mechanical ventilation-related variables. Our results provide a rationale for a more comprehensive evaluation of PPV measurement in suitable critically ill patients.
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Kim et al. (2011) conducted an observational in Non-cardiac critically ill (n=37). Pulse pressure variation (PPV) was evaluated on Correlation between PPV and tidal volume, peak airway pressure, MAP, heart rate, central venous pressure, and fluid balance. Pulse pressure variation ≥13% was present in 19% of measurements among non-cardiac critically ill patients and significantly correlated with CVP (P=0.04), HR (P<0.001), and peak airway pressure (P=0.001).
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