Key result
Pulse pressure variation is argued to be an unreliable means of guiding hemodynamic optimization due to its reliance on a nonexhaustive and incoherent physiological model.
Why the study?
Is pulse pressure variation a reliable means of guiding hemodynamic optimization in critically ill patients?
Is pulse pressure variation a reliable means of guiding hemodynamic optimization in critically ill patients?
Answers are grounded in this paper and cite their sources.
Pulse pressure variation is argued to be an unreliable metric for guiding volume expansion in critically ill patients due to complex and confounding cardiopulmonary interactions.
Hemodynamic management of critically ill patients in the ICU or high-risk patients in the operating room has paradoxically shown progress in terms of outcome after the systematic application of volume responsiveness/flow optimization based on pulse pressure variation and/or stroke volume variation during controlled, positive-pressure ventilation in patients without spontaneous respiratory efforts. This assessment of circulatory optimization should ideally be based on an exhaustive, predictive and coherent physiological understanding of the cardiovascular system model. This paper sketches the extremely complex physiological background of the concept of volume responsiveness, concluding that it is not a reliable means of guiding hemodynamic optimization because it is based on a nonexhaustive, nonpredictive and incoherent physiological model.
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Sören Söndergaard (2013) conducted a review in Hemodynamic instability in critically ill patients. Pulse pressure variation (PPV) was evaluated. Pulse pressure variation is argued to be an unreliable means of guiding hemodynamic optimization due to its reliance on a nonexhaustive and incoherent physiological model.
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