title: Applicability of Pulse Pressure Variation during Unstable Hemodynamic Events in the Intensive Care Unit: A Five-Day Prospective Multicenter Study.
abstract: Pulse pressure variation can predict fluid responsiveness in strict applicability conditions. The purpose of this study was to describe the clinical applicability of pulse pressure variation during episodes of patient hemodynamic instability in the intensive care unit. We conducted a five-day, seven-center prospective study that included patients presenting with an unstable hemodynamic event. The six predefined inclusion criteria for pulse pressure variation applicability were as follows: mechanical ventilation, tidal volume >7 mL/kg, sinus rhythm, no spontaneous breath, heart rate/respiratory rate ratio >3.6, absence of right ventricular dysfunction, or severe valvulopathy. Seventy-three patients presented at least one unstable hemodynamic event, with a total of 163 unstable hemodynamic events. The six predefined criteria for the applicability of pulse pressure variation were completely present in only 7% of these. This data indicates that PPV should only be used alongside a strong understanding of the relevant physiology and applicability criteria. Although these exclusion criteria appear to be profound, they likely represent an absolute contraindication of use for only a minority of critical care patients.
authors.affiliation: Service de Réanimation Médicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Delannoy
authors.affiliation: Service de Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Hospices Civils de Lyon, Service de Biostatistique, Lyon, France; CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Lyon 1, 69100 Villeurbanne, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Pavilion P, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, 69003 Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Page
authors.affiliation: Intensive Care Unit, Centre Hospitalier de Roanne, 42300 Roanne, France.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Kaaki
authors.affiliation: Unité de Réanimation Chirurgicale, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Université de Lyon, 69004 Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Schoeffler
authors.affiliation: Department of Anesthesiology & Perioperative Care, School of Medicine, University of California, Irvine, Orange, CA 92868, USA.
authors.forename: Brenton
authors.initials: B
authors.lastname: Alexander
authors.affiliation: Department of Anesthesiology and Intensive Care, Clinique de la Sauvegarde, 69009 Lyon, France; Université Lyon 1, EA4169, SFR Lyon-Est Santé, INSERM US 7, CNRS UMS 3453, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe