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Highly Accessed Open Badges Commentary

Pulse pressure variation: beyond the fluid management of patients with shock

Frédéric Michard1*, Marcel R Lopes2 and Jose-Otavio C Auler3

Author Affiliations

1 Department of Anesthesia and Critical Care, Béclère Hospital – University Paris XI, France

2 Department of Anesthesia and Critical Care, Santa Casa Misericordia de Passos, Passos, MG, Brazil

3 Department of Anesthesia and Critical Care, INCOR – University of São Paulo, São Paulo, SP, Brazil

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Critical Care 2007, 11:131  doi:10.1186/cc5905

See related research by Keyl et al,

Published: 17 May 2007


In anesthetized patients without cardiac arrhythmia the arterial pulse pressure variation (PPV) induced by mechanical ventilation has been shown the most accurate predictor of fluid responsiveness. In this respect, PPV has so far been used mainly in the decision-making process regarding volume expansion in patients with shock. As an indicator of the position on the Frank–Starling curve, PPV may actually be useful in many other clinical situations. In patients with acute lung injury or with acute respiratory distress syndrome, PPV can predict hemodynamic instability induced by positive end-expiratory pressure and recruitment maneuvers. PPV may also be useful to prevent excessive fluid restriction/depletion in patients with pulmonary edema, and to prevent excessive ultrafiltration in critically ill patients undergoing hemodialysis or hemofiltration. In the operating room, a goal-directed fluid therapy based on PPV monitoring has the potential to improve the outcome of patients undergoing high-risk surgery.