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Pulse pressure variation and ARDS.
MedLine Citation:
PMID:  23370121     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Fluid management is a crucial issue in patients with acute respiratory distress syndrome (ARDS). Assessment of preload responsiveness should help to define the best fluid strategy. Arterial pulse pressure variation (PPV), which represents the amplitude of the respiratory changes in arterial pulse pressure, is considered as a marker of preload responsiveness in patients mechanically ventilated and fully adapted to their ventilator. The good ability of PPV to predict fluid responsiveness has been confirmed in various clinical situations (sepsis, operative and post-operative periods). However, there are a number of limits of using PPV (e.g. spontaneous breathing activity, cardiac arrhythmias, low tidal volume ventilation, low lung compliance), which are particularly important in ARDS. Clinical studies have confirmed the poor reliability of PPV in predicting fluid responsiveness in patients with ARDS, ventilated according to the currently recommended lung protective strategy. Although a PPV > 10-12% still keeps its good predictive value, a lower PPV (< 10%) is far to guarantee fluid unresponsiveness since many false-negative cases can be encountered in this setting. Thus, performance of alternative preload responsiveness tests such as passive leg raising or end-expiratory occlusion tests, is necessary when low PPV values are measured. This review addresses the meaning of PPV, its conditions of use and its limits in ARDS patients.
Authors:
J L Teboul; X Monnet
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-31
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue duGénéral Leclerc, Le Kremlin-Bicêtre, F-94270 France - jean-louis.teboul@bct.aphp.fr.
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