Background
Heart‐lung interactions during mechanical ventilation: physiological principles underlying PPV and SVV
Comparison of dynamic changes of arterial waveform‐derived variables during mechanical ventilation (SPV, PPV and SVV)
Systematic review/metaanalysis | Publication year | Types of studies | Patient type | Variable | AUC (95% confidence interval) |
---|---|---|---|---|---|
Marik et al. [7] | 2009 | 29 studies 685 patients variable tidal volume | ICU and OR patients | PPV | 0.94 (0.93–0.95) |
SPV | 0.86 (0.82–0.90) | ||||
SVV | 0.84 (0.78–0.88) | ||||
LVEDA | 0.64 (0.53–0.74) | ||||
GEDV | 0.56 (0.37–0.67) | ||||
CVP | 0.55 (0.48–0.62) | ||||
Hong et al. [9] | 2014 | 19 studies 850 patients variable tidal volume | Only ICU patients | PPV | 0.88 (0.84–0.92) |
SVV | 0.84 (0.79–0.89) | ||||
Yang and Du [10] | 2014 | 22 studies 807 patients tidal volume > 8 ml/kg | Only ICU patients | PPV | 0.94 (0.91–0.95) |
Limitations with the use of PPV to predict fluid responsiveness
Limitations | Mechanisms for failure | Type of error | |
---|---|---|---|
1 | Spontaneous breathing activity | Irregular variations in intrathoracic pressure and thus the variation in stroke volume cannot correlate with preload dependency | False positive (may occasionally be false negative depending on the type of breathing) |
2 | Cardiac arrhythmias | The variation in stroke volume is related more to the irregularity in diastole than to the heart‐lung interactions | False positive |
3 | Mechanical ventilation using low tidal volume (<8 ml/kg) | The small variations in intrathoracic pressure due to the low tidal volume are insufficient to produce significant changes in the intrathoracic pressure | False negative |
4 | Low lung compliance | The transmission of changes in alveolar pressure to the intrathoracic structures is attenuated | False negative |
5 | Open thorax | No change in intrathoracic pressure during the respiratory cycle | False negative |
6 | Increased intra‐abdominal pressure | Threshold values of PPV will be elevated | False positive |
7 | Low HR/RR ratio < 3.6 (severe bradycardia or high frequency ventilation) | If the RR is very high, the number of cardiac cycles per respiratory cycle may be too low to allow variation in stroke volume | False negative |