Pulse pressure variation beyond the fluid management of patients with shock 英文参考文献.docVIP

Available online /content/11/3/131 Commentary Pulse pressure variation: beyond the fluid management of patients with shock Frédéric Michard1, Marcel R Lopes2 and Jose-Otavio C Auler Jr3 1Department of Anesthesia and Critical Care, Béclère Hospital – University Paris XI, France 2Department of Anesthesia and Critical Care, Santa Casa Misericordia de Passos, Passos, MG, Brazil 3Department of Anesthesia and Critical Care, INCOR – University of S?o Paulo, S?o Paulo, SP, Brazil Corresponding author: Frédéric Michard, michard.frederic@free.fr Published: 17 May 2007 Critical Care 2007, 11:131 (doi:10.1186/cc5905) This article is online at /content/11/3/131 ? 2007 BioMed Central Ltd See related research by Keyl et al., /content/11/2/R46 Abstract Briefly, patients operating on the flat portion of the Frank–Starling curve are insensitive to cyclic changes in preload induced by mechanical inspiration, such that PPV is low (Figure 1). Conversely, PPV is high in patients operating on the steep portion of the preload/stroke volume relationship (and hence sensitive to cyclic changes in preload induced by mechanical inspiration) (Figure 1). This information has so far been used mainly to predict fluid responsiveness in patients with shock, but actually could be useful in many other clinical situations. In anesthetized patients without cardiac arrhythmia the arterial pulse pressure variation (PPV) induced by mechanical ventilation has been shown the most accurate predictor of fluid responsive- ness. In this respect, PPV has so far been used mainly in the decision-making process regarding volume expansion in patients with shock. As an indicator of the position on the Frank–Starling curve, PPV may actually be useful in many other clinical situations. In patients with acute lung injury or with acute respiratory distress syndrome, PPV can predict hemodynamic instability induced by positiv