Journal of Anesthesia

, Volume 25, Issue 6, pp 904–916 | Cite as

Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis

  • Zhongheng Zhang
  • Baolong Lu
  • Xiaoyan Sheng
  • Ni Jin
Review Article



Stroke volume variation (SVV) appears to be a good predictor of fluid responsiveness in critically ill patients. However, a wide range of its predictive values has been reported in recent years. We therefore undertook a systematic review and meta-analysis of clinical trials that investigated the diagnostic value of SVV in predicting fluid responsiveness.


Clinical investigations were identified from several sources, including MEDLINE, EMBASE, WANFANG, and CENTRAL. Original articles investigating the diagnostic value of SVV in predicting fluid responsiveness were considered to be eligible. Participants included critically ill patients in the intensive care unit (ICU) or operating room (OR) who require hemodynamic monitoring.


A total of 568 patients from 23 studies were included in our final analysis. Baseline SVV was correlated to fluid responsiveness with a pooled correlation coefficient of 0.718. Across all settings, we found a diagnostic odds ratio of 18.4 for SVV to predict fluid responsiveness at a sensitivity of 0.81 and specificity of 0.80. The SVV was of diagnostic value for fluid responsiveness in OR or ICU patients monitored with the PiCCO or the FloTrac/Vigileo system, and in patients ventilated with tidal volume greater than 8 ml/kg.


SVV is of diagnostic value in predicting fluid responsiveness in various settings.


Meta-analysis Stroke volume variation Fluid responsiveness 


Conflict of interest

The authors declared that they have no conflict of interest.


  1. 1.
    Antonelli M, Levy M, Andrews PJ, Chastre J, Hudson LD, Manthous C, Meduri GU, Moreno RP, Putensen C, Stewart T, Torres A. Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27–28 April 2006. Intensive Care Med. 2007;33:575–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008;36:296–327.Google Scholar
  3. 3.
    Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, de Boisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564–75.PubMedCrossRefGoogle Scholar
  4. 4.
    Stewart RM, Park PK, Hunt JP, McIntyre RC Jr, McCarthy J, Zarzabal LA, Michalek JE. Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring. J Am Coll Surg. 2009;208:725–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Calvin JE, Driedger AA, Sibbald WJ. The hemodynamic effect of rapid fluid infusion in critically ill patients. Surgery (St. Louis). 1981;90:61–76.Google Scholar
  6. 6.
    Wagner JG, Leatherman JW. Right ventricular end-diastolic volume as a predictor of the hemodynamic response to a fluid challenge. Chest. 1998;113:1048–54.PubMedCrossRefGoogle Scholar
  7. 7.
    Magder S, Lagonidis D. Effectiveness of albumin vs. normal saline as a test of volume responsiveness in post-cardiac surgery patients. J Crit Care. 1999;14:164–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL. Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med. 2000;162:134–8.PubMedGoogle Scholar
  9. 9.
    Charron C, Fessenmeyer C, Cosson C, Mazoit JX, Hebert JL, Benhamou D, Edouard AR. The influence of tidal volume on the dynamic variables of fluid responsiveness in critically ill patients. Anesth Analg. 2006;102:1511–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Natalini G, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A. Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg. 2006;103:1478–84.PubMedCrossRefGoogle Scholar
  11. 11.
    Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bendjelid K. Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med. 2007;33:993–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Marik PE, Cavallazzi R, Vasu T, Hirani A. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Metaanalysis of Observational Studies in Epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. JAMA. 2000;283:2008–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.PubMedCrossRefGoogle Scholar
  15. 15.
    Field AP. Meta-analysis of correlation coefficients: a Monte Carlo comparison of fixed- and random-effects methods. Psychol Methods 2001;6:161–180.Google Scholar
  16. 16.
    McClish DK. Combining and comparing area estimates across studies or strata. Med Decis Mak 1992;12:274–9.Google Scholar
  17. 17.
    Harbord RM, Whiting P. Metandi: meta-analysis of diagnostic accuracy using hierarchical logistic regression. Stata J. 2009;9:211–29.Google Scholar
  18. 18.
    Lau J, Ioannidis JP, Terrin N, Schmid CH, Olkin I. The case of the misleading funnel plot. BMJ 2006;333:597–600.Google Scholar
  19. 19.
    Perner A, Faber T. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand. 2006;50:1068–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Muller L, Louart G, Bousquet PJ, Candela D, Zoric L, de La Coussaye JE, Jaber S, Lefrant JY. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Med. 2010;36:496–503.PubMedCrossRefGoogle Scholar
  21. 21.
    Reuter DA, Felbinger TW, Kilger E, Schmidt C, Lamm P, Goetz AE. Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations. Comparison with aortic systolic pressure variations. Br J Anaesth. 2002;88:124–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Belloni L, Pisano A, Natale A, Piccirillo MR, Piazza L, Ismeno G, De Martino G. Assessment of fluid-responsiveness parameters for off-pump coronary artery bypass surgery: a comparison among LiDCO, transesophageal echochardiography, and pulmonary artery catheter. J Cardiothorac Vasc Anesth. 2008;22:243–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Berkenstadt H, Margalit N, Hadani M, Friedman Z, Segal E, Villa Y, Perel A. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Biais M, Nouette-Gaulain K, Cottenceau V, Revel P, Sztark F. Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. Br J Anaesth. 2008;101:761–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Biais M, Bernard O, Ha JC, Degryse C, Sztark F. Abilities of pulse pressure variations and stroke volume variations to predict fluid responsiveness in prone position during scoliosis surgery. Br J Anaesth. 2010;104:407–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Cannesson M, Musard H, Desebbe O, Boucau C, Simon R, Hénaine R, Lehot JJ. The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients. Anesth Analg. 2009;108:513–7.PubMedCrossRefGoogle Scholar
  27. 27.
    He-Mei W, Jia HQ, Yong FF, Li C, Wang Y, Zhao W. Correlation between stroke volume variation and blood volume. Chin J Anesthesiol. 2010;30:814–6.Google Scholar
  28. 28.
    Hofer CK, Müller SM, Furrer L, Klaghofer R, Genoni M, Zollinger A. Stroke volume and pulse pressure variation for prediction of fluid responsiveness in patients undergoing off-pump coronary artery bypass grafting. Chest. 2005;128:848–54.PubMedCrossRefGoogle Scholar
  29. 29.
    Hofer CK, Senn A, Weibel L, Zollinger A. Assessment of stroke volume variation for prediction of fluid responsiveness using the modified FloTrac and PiCCOplus system. Crit Care. 2008;12:R82.Google Scholar
  30. 30.
    Huang CC, Fu JY, Hu HC, Kao KC, Chen NH, Hsieh MJ, Tsai YH. Prediction of fluid responsiveness in acute respiratory distress syndrome patients ventilated with low tidal volume and high positive end-expiratory pressure. Crit Care Med. 2008;36:2810–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Lahner D, Kabon B, Marschalek C, Chiari A, Pestel G, Kaider A, Fleischmann E, Hetz H. Evaluation of stroke volume variation obtained by arterial pulse contour analysis to predict fluid responsiveness intraoperatively. Br J Anaesth. 2009;103:346–51.PubMedCrossRefGoogle Scholar
  32. 32.
    Lei H, Zhang WX, Cai WX, Luo H, Chen YQ, Zhang S. The role of stroke volume variation in predicting the volume responsiveness of patients with severe sepsis and septic shock. Chin J Emerg Med. 2010;19:916–20.Google Scholar
  33. 33.
    Marx G, Cope T, McCrossan L, Swaraj S, Cowan C, Mostafa SM, Wenstone R, Leuwer M. Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis. Eur J Anaesthesiol. 2004;21:132–8.PubMedGoogle Scholar
  34. 34.
    Preisman S, Kogan S, Berkenstadt H, Perel A. Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators. Br J Anaesth. 2005;95:746–55.PubMedCrossRefGoogle Scholar
  35. 35.
    Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, Goetz AE. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med. 2002;28:392–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Reuter DA, Kirchner A, Felbinger TW, Weis FC, Kilger E, Lamm P, Goetz AE. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med. 2003;31:1399–404.PubMedCrossRefGoogle Scholar
  37. 37.
    Rex S, Brose S, Metzelder S, Hüneke R, Schälte G, Autschbach R, Rossaint R, Buhre W. Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth. 2004;93:782–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Suehiro K, Okutani R. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation. J Cardiothorac Vasc Anesth. 2010;24:772–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Wiesenack C, Prasser C, Rödig G, Keyl C. Stroke volume variation as an indicator of fluid responsiveness using pulse contour analysis in mechanically ventilated patients. Anesth Analg. 2003;96:1254–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Wiesenack C, Fiegl C, Keyser A, Prasser C, Keyl C. Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients. Eur J Anaesthesiol. 2005;22:658–65.PubMedCrossRefGoogle Scholar
  41. 41.
    Wyffels PA, Sergeant P, Wouters PF. The value of pulse pressure and stroke volume variation as predictors of fluid responsiveness during open chest surgery. Anaesthesia. 2010;65:704–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Yu YH, Dai HW, Yan ML, Gong SJ, Cai GL, Zhang ZC, Chen J, Yan J. An evaluation of stroke volume variation as a predictor of fluid responsiveness in mechanically ventilated elderly patients with severe sepsis. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2009;21:463–5.PubMedGoogle Scholar
  43. 43.
    Zhang HM, Liu DW, Wang XT, Rui X, Wang H, He HW, Liu Y, Chen XK. Stroke volume variation in the evaluation of fluid responsiveness in refractory septic shock. Zhonghua Nei Ke Za Zhi. 2010;49:610–3.PubMedGoogle Scholar
  44. 44.
    Zimmermann M, Feibicke T, Keyl C, Prasser C, Moritz S, Graf BM, Wiesenack C. Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery. Eur J Anaesthesiol. 2010;27:555–61.PubMedGoogle Scholar
  45. 45.
    Heenen S, De Backer D, Vincent JL. How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? Crit Care. 2006;10:R102.Google Scholar
  46. 46.
    Soubrier S, Saulnier F, Hubert H, Delour P, Lenci H, Onimus T, Nseir S, Durocher A. Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients? Intensive Care Med. 2007;33:1117–24.PubMedCrossRefGoogle Scholar
  47. 47.
    Vistisen ST, Koefoed-Nielsen J, Larsson A. Should dynamic parameters for prediction of fluid responsiveness be indexed to the tidal volume? Acta Anaesthesiol Scand. 2010;54:191–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Petrucci N, Iacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2004;(2):CD003844Google Scholar
  49. 49.
    Button D, Weibel L, Reuthebuch O, Genoni M, Zollinger A, Hofer CK. Clinical evaluation of the FloTrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth. 2007;99:329–36.PubMedCrossRefGoogle Scholar
  50. 50.
    Cannesson M, Attof Y, Rosamel P, Joseph P, Bastien O, Lehot JJ. Comparison of FloTrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements. Eur J Anaesthesiol. 2007;24:832–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Compton FD, Zukunft B, Hoffmann C, Zidek W, Schaefer JH. Performance of a minimally invasive uncalibrated cardiac output monitoring system (Flotrac/Vigileo) in haemodynamically unstable patients. Br J Anaesth. 2008;100:451–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Opdam HI, Wan L, Bellomo R. A pilot assessment of the FloTrac cardiac output monitoring system. Intensive Care Med. 2007;33:344–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Monnet X, Anguel N, Naudin B, Jabot J, Richard C, Teboul JL. Arterial pressure-based cardiac output in septic patients: different accuracy of pulse contour and uncalibrated pressure waveform devices. Crit Care. 2010;14:R109.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2011

Authors and Affiliations

  • Zhongheng Zhang
    • 1
  • Baolong Lu
    • 1
  • Xiaoyan Sheng
    • 1
  • Ni Jin
    • 1
  1. 1.Department of Critical Care MedicineJinhua Central HospitalJinhuaPeople’s Republic of China

Personalised recommendations