Related Experiment Video
Updated: May 14, 2026
06:22
Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome (ARDS)
Published on: April 7, 2021
Pulse pressure variation and ARDS
1Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale, Le Kremlin-Bicêtre, France. jean-louis.teboul@bct.aphp.fr
Minerva Anestesiologica
|February 2, 2013
Summary
Fluid management in ARDS patients is complex. Arterial pulse pressure variation (PPV) is unreliable for predicting fluid responsiveness, necessitating alternative methods like passive leg raising in ARDS patients.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Hemodynamic Monitoring
Background:
- Fluid management is critical for Acute Respiratory Distress Syndrome (ARDS) patients.
- Assessing fluid responsiveness guides optimal fluid strategies.
- Arterial pulse pressure variation (PPV) is a common preload responsiveness marker in ventilated patients.
Purpose of the Study:
- To review the utility and limitations of PPV in ARDS.
- To highlight the challenges of PPV in ARDS patients on lung-protective ventilation.
- To discuss alternative methods for fluid responsiveness assessment in ARDS.
Main Methods:
- Review of clinical studies and literature on PPV in ARDS.
- Analysis of factors affecting PPV reliability in ARDS.
- Comparison of PPV with other preload responsiveness tests.
Main Results:
- PPV reliability is significantly reduced in ARDS patients, especially with lung-protective ventilation.
- Low PPV values (<10%) in ARDS do not reliably exclude fluid responsiveness, with frequent false negatives.
- PPV remains a useful indicator when values are high (>10-12%).
Conclusions:
- PPV is often unreliable for guiding fluid therapy in ARDS.
- Alternative methods like passive leg raising or end-expiratory occlusion tests are recommended when PPV is low.
- Careful consideration of PPV limitations is essential for appropriate fluid management in ARDS.
Related Concept Videos
01:17Measurement of Blood Pressure
Assessing blood pressure is a standard procedure executed in virtually all medical environments. The method utilized today was established over a hundred years ago by an innovative Russian doctor, Dr. Nikolai Korotkoff. The soft ticking noise, known as Korotkoff sounds, heard while taking blood pressure readings results from turbulent blood flow within the vessels. The apparatus required for this procedure includes a sphygmomanometer, a blood pressure cuff attached to a gauge, and a stethoscope.
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
01:21Sites for measuring blood pressure
Blood pressure measurement is a fundamental clinical procedure, providing crucial data for assessing cardiovascular health. Among the various sites for this measurement, the brachial and popliteal arteries are predominantly utilized due to their accessibility and the reliability of their readings. This lesson delves into the anatomical significance, methodology, and considerations of measuring blood pressure at these locations.
The Brachial Artery: Primary Site for Blood Pressure Measurement
The Brachial Artery: Primary Site for Blood Pressure Measurement
01:24Blood Pressure
The movement of blood in a human body, commonly referred to as blood flow, is determined by the volume of blood that traverses a certain section of the bodily system per unit time. It is the rhythmic contraction of the heart's ventricles that primarily instigates this movement. As the ventricles contract, blood is forced into the prominent arteries, which then flow from areas of greater pressure to lower pressure areas. This movement continues into smaller arteries and arterioles and...
01:16Pulse
When the heart pumps blood out, arterial elastic fibers play a crucial role in sustaining a high-pressure gradient. They expand to accommodate the received blood and then recoil - a process known as the pulse that can be either manually palpated or electronically quantified. Despite a reduction in its effect with increased distance from the heart, elements of the pulse's systolic and diastolic components persist, observable even at the arteriole level.
The pulse serves as a clinical indicator...
The pulse serves as a clinical indicator...
01:24Pressure Relationships in Thoracic Cavity
Breathing, otherwise known as pulmonary ventilation, is the process of air movement into and out of the lungs. The main mechanisms propelling pulmonary ventilation are atmospheric pressure (Patm), intra-pulmonary (Ppul ) or intra-alveolar pressure (Palv) within the alveoli, and intrapleural pressure (Pip) within the pleural cavity.
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs during...
Breathing Mechanisms
Both intra-alveolar and intrapleural pressures rely on specific lung properties. The ability to breathe—allowing air to enter the lungs during...