Skip to main content

A systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery

Abstract

This systematic review aims to summarize the published data on the reliability of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness in an open-chest setting during cardio-thoracic surgery. The analysis included studies reporting receiver operating characteristics or correlation coefficients between PPV/SVV and change in any hemodynamic variables after a fluid challenge test in open-chest conditions. The literature search included seven studies. Increase in cardiac index and stroke volume index after a fluid challenge were the most adopted end-point variables. PPV and SVV showed similar area under the receiver operating characteristic curve values but high heterogeneity among studies. Cardiac and thoracic studies did not differ between PPV/SVV pooled area under the receiver operating characteristic curve. Studies exploring correlation between dynamic indices and end-point variable increase after fluid challenge showed conflicting results. The great heterogeneity between studies was due to small sample size and differences among protocol designs (different monitor devices, mechanical ventilation settings, fluid challenge methodologies, surgical incisions, and end-point variables). PPV and SVV seem to be inaccurate in predicting fluid responsiveness in an open-chest setting during cardio-thoracic surgery. Given the high heterogeneity of published data, more studies are needed to define the role of PPV/SVV in this context.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Cannesson M, Aboy M, Hofer CK. Pulse pressure variation: where are we today? J Clin Monit Comput. 2011;25:45–56.

    Article  PubMed  Google Scholar 

  2. Lobo SM, Mendes CL, Rezende E, Dias FS. Optimizing perioperative hemodynamics: what is new? Curr Opin Crit Care. 2013;19:346–52.

    Article  PubMed  Google Scholar 

  3. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392–402.

    Article  PubMed  Google Scholar 

  4. Aya HD, Cecconi M, Hamilton MA, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013;110:510–7.

    CAS  Article  PubMed  Google Scholar 

  5. Zhang J, Chen CQ, Lei XZ, Feng ZY, Zhu SM. Goal-directed fluid optimization based on stroke volume variation and cardiac index during one-lung ventilation in patients undergoing thoracoscopy lobectomy operations: a pilot study. Clinics (Sao Paulo). 2013;68:1065–70.

    Article  Google Scholar 

  6. Reuter DA, Goresch T, Goepfert MSG, Whildirt SM, Kilger E, Goetz AE. Effects of mid-line thoracotomy on the interaction between mechanical ventilation and cardiac filling during cardiac surgery. Br J Anaesth. 2004;92:808–13.

    CAS  Article  PubMed  Google Scholar 

  7. Lorne E, Mahjoub Y, Zogheib E, Debec G, Ben Ammar A, Trojette F, Dehedin B, Remadi JP, Caus T, Dupont H. Influence de l’ouverture du thorax par sternotomie sur les variations respiratoires de la pression pulsé. Ann Fr Anesth Reanim. 2011;30:117–21.

    CAS  Article  PubMed  Google Scholar 

  8. Rex S, Schalte G, Schroth S, De Waal EEC, Metzelder S, Overbeck Y, Rossaint R, Buhre W. Limitations of arterial pulse pressure variation and left ventricular stroke volume variation in estimating cardiac pre-load during open heart surgery. Acta Anaesthesiol Scand. 2007;51:1258–67.

    CAS  PubMed  Google Scholar 

  9. Piccioni F, Bernasconi F, Tramontano G. A systematic review and meta-analysis of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery. PROSPERO 2015:CRD42015028071. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015028071. Accessed 26 Mar 2016.

  10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.

    Article  PubMed  Google Scholar 

  11. National Heart, Lung and Blood Institute of the American National Institute of Health. https://www.nhlbi.nih.gov/health-pro/guidelines/in-develop/cardiovascular-risk-reduction/tools/before-after. Accessed 15 Sept 2015.

  12. Wyffels PAH, 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.

    CAS  Article  PubMed  Google Scholar 

  13. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:13.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Reuter DA, Goepfert MSG, Goresch T, Schmoeckel M, Kilger E, Goetz AE. Assessing fluid responsiveness during open chest conditions. Br J Anaesth. 2005;94:318–23.

    CAS  Article  PubMed  Google Scholar 

  15. De Waal EEC, Rex S, Kruitwagen CLJJ, Kalkman CJ, Buhre WF. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Crit Care Med. 2009;37:510–5.

    Article  PubMed  Google Scholar 

  16. Suehiro K, Okutani R. Stroke volume variation as a predictor of fluid responsiveness in patients. J Cardiothorac Vasc Anesth. 2010;24:772–5.

    Article  PubMed  Google Scholar 

  17. Suehiro K, Okutani R. Influence of tidal volume for stroke volume variation to predict fluid responsiveness in patients undergoing one-lung ventilation. J Anesth. 2011;25:777–80.

    Article  PubMed  Google Scholar 

  18. Lee J, Jeon Y, Bahk JH, Gil NS, Hong DM, Kim JH, Kim HJ. Pulse pressure variation as a predictor of fluid responsiveness during one-lung ventilation for lung surgery using thoracotomy: randomised controlled study. Eur J Anaesthesiol. 2011;28:39–44.

    Article  PubMed  Google Scholar 

  19. Fu Q, Zhao F, Mi W, Zhang H. Stroke volume variation fail to predict fluid responsiveness in patients undergoing pulmonary lobectomy with one-lung ventilation using thoracotomy. BioSci Trends. 2014;8:59–63.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. Kubitz JC, Annecke T, Kemming GI, Forkl S, Kronas N, Goetz AE, Reuter DA. The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions. Eur J Cardio-thoracic Surg. 2006;30:90–5.

    Article  Google Scholar 

  22. De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL. Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med. 2005;31:517–23.

    Article  PubMed  Google Scholar 

  23. Reuter DA, Bayerlein J, Goepfert MSG, Weis FC, Kilger E, Lamm P, Goetz AE. Influence of tidal volume on left ventricular stroke volume variation measured by pulse contour analysis in mechanically ventilated patients. Intensive Care Med. 2003;29:476–80.

    Article  PubMed  Google Scholar 

  24. Haas S, Eichhorn V, Hasbach T, Trepte C, Kutup A, Goetz AE, Reuter DA. Goal-directed fluid therapy using stroke volume variation does not result in pulmonary fluid overload in thoracic surgery requiring one-lung ventilation. Crit Care Res Pract. 2012;2012:687018.

    PubMed  PubMed Central  Google Scholar 

  25. Kapoor PM, Kakani M, Chowdhury U, Choudhury M, Lakshmy R, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth. 2008;11:27–34.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Alexa Ahern for linguistic revision of this paper.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Federico Piccioni.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Piccioni, F., Bernasconi, F., Tramontano, G.T.A. et al. A systematic review of pulse pressure variation and stroke volume variation to predict fluid responsiveness during cardiac and thoracic surgery. J Clin Monit Comput 31, 677–684 (2017). https://doi.org/10.1007/s10877-016-9898-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-016-9898-5

Keywords

  • Anesthesia, general
  • Cardiac surgical procedure
  • Fluid therapy
  • Meta-analysis as topic
  • Pulse wave analysis
  • Thoracic surgery