Monitoring of pulse pressure variation using a new smartphone application (Capstesia) versus stroke volume variation using an uncalibrated pulse wave analysis monitor: a clinical decision making study during major abdominal surgery

  • Alexandre JoostenEmail author
  • Alexandra Jacobs
  • Olivier Desebbe
  • Jean-Louis Vincent
  • Saxena Sarah
  • Joseph Rinehart
  • Luc Van Obbergh
  • Alexander Hapfelmeier
  • Bernd Saugel
Original Research


Pulse pressure variation (PPV) and stroke volume variation (SVV) can be used to assess fluid status in the operating room but usually require dedicated advanced hemodynamic monitors. Recently, a smartphone application (Capstesia™), which automatically calculates PPV from a picture of the invasive arterial pressure waveform from any monitor screen (PPVCAP), has been developed. The purpose of this study was to compare PPVCAP with SVV from an uncalibrated pulse wave analysis monitor (SVVPC). In 40 patients undergoing major abdominal surgery, we compared PPVCAP with SVVPC at post-induction, pre-incision, post-incision, end of surgery, and during every hypotensive episode (mean arterial pressure < 65 mmHg). We classified PPVCAP and SVVPC into three categories reflecting the thresholds used for the decision to administer fluids: no fluid administration (PPV and SVV < 9%), gray zone (PPV and SVV 9–13%), and fluid administration (PPV and SVV > 13%). The agreement between SVVPC and PPVCAP for these three categories was measured by the number of concordant paired measurements divided by the total number of paired measurements and Cohen’s kappa coefficient. In the 549 pairs of PPV–SVV data obtained, the overall agreement of PPVCAP with SVVPC was 79%, and the kappa coefficient was moderate (0.55). The highest agreement and kappa coefficient value were observed after the induction of anesthesia before surgical incision. PPVCAP and SVVPC would have resulted in completely opposite clinical decisions regarding fluid administration in 1% of the cases. In this clinical decision making study in patients undergoing major abdominal surgery, we observed a moderate agreement between PPVCAP and SVVPC with regard to categories used to guide fluid administration.

Trial Registration: Clinical (NCT03137901).


Mobile technology Feature extraction technology Monitoring Fluid responsiveness 



All the Anesthesiology department for their assistance.

Author contributions

AJ: Designed the study, analyzed the data and drafted the manuscript. AJ, OD: Designed the study, analyzed the data and edited the manuscript. JLV, SS, JR, LVO: Analyzed the data and edited the manuscript. AH: Analyzed the data (statistical analysis) and edited the manuscript. BS: Analyzed the data and drafted the manuscript. All authors read and approved the final version of the manuscript.


This work was supported by the Department of Anesthesiology, Erasme Hospital, Brussels.

Compliance with ethical standards

Conflict of interest

Alexandre Joosten: Consultant for Edwards Lifesciences (Irvine, CA, USA). Olivier Desebbe: Collaborates with Medtronic (Dublin, Ireland) as a consultant and received honoraria for giving lectures. Jean-Louis Vincent is Editor-in-Chief of Critical Care. He has no other conflicts related to this article. Joseph Rinehart: Ownership interest in Sironis, a company developing closed-loop medical software, consultant for Edwards Lifesciences (Irvine, CA, USA). Bernd Saugel: Collaborates with Pulsion Medical Systems (Feldkirchen, Germany) as a member of the medical advisory board and received honoraria for giving lectures and refunds of travel expenses from Pulsion Medical Systems. BS received institutional research grants, unrestricted research grants, and refunds of travel expenses from Tensys Medical (San Diego, CA, USA). BS received honoraria for giving lectures and refunds of travel expenses from CNSystems Medizintechnik (Graz, Austria). BS received honoraria for giving lectures and research support from Edwards Lifesciences (Irvine, CA, USA). All other authors have no conflicts of interest to declare.

Supplementary material

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Supplementary material 1 (GIF 14 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Alexandre Joosten
    • 1
    • 2
    Email author
  • Alexandra Jacobs
    • 1
  • Olivier Desebbe
    • 3
  • Jean-Louis Vincent
    • 4
  • Saxena Sarah
    • 1
  • Joseph Rinehart
    • 5
  • Luc Van Obbergh
    • 1
  • Alexander Hapfelmeier
    • 6
  • Bernd Saugel
    • 7
  1. 1.Department of Anesthesiology, CUB Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Department of Anesthesiology and Intensive CareHôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris (AP-HP)Le Kremlin-BicêtreFrance
  3. 3.Department of Anesthesiology and Intensive CareClinique de la SauvegardeLyonFrance
  4. 4.Department of Intensive Care, CUB Erasme University HospitalUniversité Libre de BruxellesBrusselsBelgium
  5. 5.Department of Anesthesiology and Perioperative CareUniversity of California IrvineOrangeUSA
  6. 6.Institute of Medical Informatics, Statistics and EpidemiologyTechnische Universität MünchenMunichGermany
  7. 7.Department of Anesthesiology, Center of Anesthesiology and Intensive Care MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany

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