Anest. intenziv. Med. 2023;34(3):110-115 | DOI: 10.36290/aim.2023.036

Selected limitations of the use of stroke volume and pulse pressure variationsReview Article

Cenková B.^{1, 2, 3}, Šrámek V.^{2, 3}, Suk P.^{1, 2, 3}

¹ Mezinárodní centrum klinického výzkumu, Fakultní nemocnice u sv. Anny v Brně

² Anesteziologicko­‑resuscitační klinika, Fakultní nemocnice u sv. Anny v Brně

³ Lékařská fakulta, Masarykova univerzita, Brno

The concept of prediction of fluid responsiveness - the ability of the heart to increase cardiac output in a response to a fluid bolus, has become a popular choice to guide fluid resuscitation in case of circulatory failure. Stroke volume variation (SVV) and pulse pressure variation (PPV) are dynamic parameters frequently used to predict fluid responsiveness that have been shown to be accurate in a number of studies. In the operating theatre, but mainly in the setting of intensive care unit, there are multiple factors that decrease PPV/SVV reliability or make their use even impossible. Firstly, the choice of monitoring technique can influence PPV/SVV values and optimal threshold values can differ among various devices. Low tidal volume and low pulmonary compliance are limiting factors that have been studied thoroughly and can be overcome with a tidal volume challenge - a temporary increase in tidal volume for the sole purpose of taking reliable PPV/SVV measurements. On the other hand, PPV/SVV evaluation remains useless in patients with spontaneous breathing activity. There are not enough data to draw conclusions in case of false-positivity of PPV/SVV in patients suffering from right ventricular failure. PPV/SVV performance is probably weakened, yet good enough, for clinical practice in patients with left ventricular failure. Studies on intraabdominal hypertension have reported conflicting results; nevertheless, the ideal threshold values tend to be higher during elevated intraabdominal pressure. The change in variation after fluid challenge (ΔPPV/ΔSVV) appears a useful tool to validate fluid administration efficacy.

Keywords: stroke volume variation, pulse pressure variation, limitation, fluid responsiveness.

Received: May 11, 2023; Revised: July 25, 2023; Accepted: August 7, 2023; Prepublished online: September 19, 2023; Published: October 31, 2023  Show citation