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Updated: May 7, 2026
Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Pulse pressure variation and stroke volume variation to predict fluid responsiveness in patients undergoing carotid
Kyung Mi Kim1, Mi Sook Gwak, Soo Joo Choi
1Department of Anesthesiology and Pain Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
Insights
Pulse pressure variation (PPV) and stroke volume variation (SVV) accurately predict fluid responsiveness during carotid endarterectomy. These dynamic indices help optimize fluid management and improve patient outcomes.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Cardiovascular Surgery
- Hemodynamic Monitoring
Background:
- Maintaining hemodynamic stability is crucial during carotid endarterectomy (CEA) to prevent perioperative complications.
- Dynamic preload indices like pulse pressure variation (PPV) and stroke volume variation (SVV) are increasingly used in mechanically ventilated patients.
- Their utility in CEA patients requires further evaluation.
Purpose of the Study:
- To assess the accuracy of PPV and SVV in predicting fluid responsiveness in patients undergoing CEA.
- To determine if these dynamic indices can guide fluid management during this procedure.
Main Methods:
- Twenty-seven patients undergoing CEA were included.
- PPV, SVV, and cardiac output (CO) were measured before and after fluid loading.
- Fluid responsiveness was defined as a ≥15% increase in CO.
- Receiver operating characteristic (ROC) analysis was used to evaluate predictive accuracy.
Main Results:
- Both PPV and SVV correlated with CO changes after fluid expansion.
- ROC analysis indicated PPV (AUC=0.854) and SVV (AUC=0.841) accurately predicted fluid responsiveness.
- Optimal thresholds were PPV ≥9.5% (sensitivity 71.4%, specificity 90.9%) and SVV ≥7.5% (sensitivity 92.9%, specificity 63.6%).
Conclusions:
- PPV and SVV values measured before fluid loading are associated with increased CO post-volume expansion.
- These dynamic indices are valuable predictors of fluid responsiveness in CEA patients.
- They can aid in optimizing perioperative fluid management.
Background:
During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA.
Methods:
Twenty seven patients undergoing CEA were enrolled in this study. PPV, SVV and cardiac output (CO) were measured before and after fluid loading of 500 ml of hydroxyethyl starch solution. Fluid responsiveness was defined as an increase in CO ≥ 15%. The ability of PPV and SVV to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) analysis.
Results:
Both PPV and SVV measured before fluid loading are associated with changes in CO caused by fluid expansion. The ROC analysis showed that PPV and SVV predicted response to volume loading (area under the ROC curve = 0.854 and 0.841, respectively, P < 0.05). A PPV ≥ 9.5% identified responders (Rs) with a sensitivity of 71.4% and a specificity of 90.9%, and a SVV ≥ 7.5% identified Rs with a sensitivity of 92.9% and a specificity of 63.6%.
Conclusions:
Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.
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