Should We Offer the Surgeon a Break?

Le Manach et al. present a study demonstrating the experimental applicability of changes in pulse pressure variation (dPPV) for the prediction of changes in cardiac output (dCO). The study is accompanied by a panegyric editorial answering the rhetorical question whether we need to monitor CO during surgery with a resounding NO! We now have dPPV!1,2 There is, however, a number of considerations to be made before this opinionist view is accepted—or rejected.YES, we have to measure CO in high-risk surgery to optimize oxygen delivery.YES, we have to use validated and calibrated dilution methods with continuous, updated arterial curve–based calculation of CO, andYES, we have to adopt a cardiovascular model capable of integrating heart efficiency, vasomotor tone, and stressed volume in the assessment of cardiovascular optimization. Guyton’s histocentric model is one suggestion. In one sweep, it updates the Starling-based PPV of 189619 to Guyton-based venous return physiology of 1963.20And, YES, key opinion holders in the European intensive care community should be very cautious in promoting this PPV dream of cardiovascular control.The PPV methodology is an instructive reflection of complex cardiopulmonary physiology, and it has not, though, attained the sophistication to be of reliable use clinically.