Pulse pressure variability as a predictor of volume responsiveness in patients with sepsis
Comments Michard et al have found an excellent correlation between pulse pressure variability and the response to fluid challenge in a group of mechanically ventilated patients with sepsis and circulatory failure. Although there is no gold standard for the assessment of volume status, fluid responsiveness is what actually matters, and an increase in cardiac index (CI) of 15% with fluid challenge seems to be an adequate comparison. Pulse pressure variability of 13% allowed for discrimination
... discrimination between responders and nonresponders, with a sensitivity of 94% and a specificity of 96%. A poor correlation with a commonly used predictor -pulmonary capillary wedge pressure (PCWP) -is notable. These results need further confirmation, and the test needs defining in other groups of critically ill patients. In mechanically ventilated patients with sepsis, pulse pressure variability (easily obtained from bedside monitoring equipment) can be used as a supplement to clinical examination in the assessment of fluid status and responsiveness. It must be stressed that arrhythmias and spontaneous breathing activity can lead to misinterpretation of respiratory changes in arterial pressure.