Pulse pressure variation and stroke volume variation: from flying blind to flying right?

摘要

Editor-We read with interest two recent publications in the British Journal of Anaesthesia by Gouvea and colleagues1 who manually assessed pulse pressure variation (PPV) and by Lahner and colleagues2 about automatically calculated stroke volume variation (SVV). These articles concluded that PPV and SVV are not accurate predictors of fluid responsiveness (FR). As pointed out by the authors themselves, their results are in contradiction with previously published studies. Indeed, more than 25 peer-reviewed articles have demonstrated the value of PPV and SVV as predictors of FR, sometimes in similar setting. Regrettably no convincing explanation is given as eloquently illustrated by the summary statement of Gouvea and colleagues about PPV: 'The reasons why this dynamic index was unreliable in this setting remain unclear'. Consequently, we feel the need to propose some explanations for these unexpected results.