title: Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study.
abstract: BACKGROUND
  Respiratory variation in pulse pressure (ΔPP) is commonly used to predict the fluid responsiveness of critically ill patients. However, some researchers have demonstrated that this measurement has several limitations. The present study was designed to evaluate the proportion of patients satisfying criteria for valid application of ΔPP at a given time-point.
  
  
  METHODS
  A 1 day, prospective, observational, point-prevalence study was performed in 26 French intensive care units (ICUs). All patients hospitalized in the ICUs on the day of the study were included. The ΔPP validity criteria were recorded prospectively and defined as follows: (i) mechanical ventilation in the absence of spontaneous respiration; (ii) regular cardiac rhythm; (iii) tidal volume ≥8 ml kg(-1) of ideal body weight; (iv) a heart rate/respiratory rate ratio >3.6; (v) total respiratory system compliance ≥30 ml cm H2O(-1); and (vi) tricuspid annular peak systolic velocity ≥0.15 m s(-1).
  
  
  RESULTS
  The study included 311 patients with a Simplified Acute Physiology Score II of 41 (39-43). Overall, only six (2%) patients satisfied all validity criteria. Of the 170 patients with an arterial line in place, only five (3%) satisfied the validity criteria. During the 24 h preceding the study time-point, fluid responsiveness was assessed for 79 patients. ΔPP had been used to assess fluid responsiveness in 15 of these cases (19%).
  
  
  CONCLUSIONS
  A very low percentage of patients satisfied all criteria for valid use of ΔPP in the evaluation of fluid responsiveness. Physicians must consider limitations to the validity of ΔPP before using this variable.
authors.affiliation: Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Saint-Quentin, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Mahjoub
authors.forename: V
authors.initials: V
authors.lastname: Lejeune
authors.forename: L
authors.initials: L
authors.lastname: Muller
authors.forename: S
authors.initials: S
authors.lastname: Perbet
authors.forename: L
authors.initials: L
authors.lastname: Zieleskiewicz
authors.forename: F
authors.initials: F
authors.lastname: Bart
authors.forename: B
authors.initials: B
authors.lastname: Veber
authors.forename: C
authors.initials: C
authors.lastname: Paugam-Burtz
authors.forename: S
authors.initials: S
authors.lastname: Jaber
authors.forename: A
authors.initials: A
authors.lastname: Ayham
authors.forename: E
authors.initials: E
authors.lastname: Zogheib
authors.forename: S
authors.initials: S
authors.lastname: Lasocki
authors.forename: A
authors.initials: A
authors.lastname: Vieillard-Baron
authors.forename: H
authors.initials: H
authors.lastname: Quintard
authors.forename: O
authors.initials: O
authors.lastname: Joannes-Boyau
authors.forename: G
authors.initials: G
authors.lastname: Plantefève
authors.forename: P
authors.initials: P
authors.lastname: Montravers
authors.forename: S
authors.initials: S
authors.lastname: Duperret
authors.forename: M
authors.initials: M
authors.lastname: Lakhdari
authors.forename: N
authors.initials: N
authors.lastname: Ammenouche
authors.forename: E
authors.initials: E
authors.lastname: Lorne
authors.forename: M
authors.initials: M
authors.lastname: Slama
authors.forename: H
authors.initials: H
authors.lastname: Dupont
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D056152:Respiratory Rate / Q000502:physiology; D013990:Tidal Volume / Q000502:physiology; D014261:Tricuspid Valve / Q000503:physiopathology
keywords: fluid responsiveness; haemodynamic monitoring; pulse pressure variation