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CLC number: R44

On-line Access: 2018-07-04

Received: 2017-05-07

Revision Accepted: 2017-11-20

Crosschecked: 2018-06-06

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Citations:  Bibtex RefMan EndNote GB/T7714


Wolfgang Huber


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Journal of Zhejiang University SCIENCE B 2018 Vol.19 No.7 P.515-524


Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

Author(s):  Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel

Affiliation(s):  II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, D-81675 München, Germany; more

Corresponding email(s):   Wolfgang.Huber@tum.de

Key Words:  Hemodynamic monitoring, Preload, Fluid responsiveness, Stroke volume variation, Pulse pressure variation

Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel. Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients[J]. Journal of Zhejiang University Science B, 2018, 19(7): 515-524.

@article{title="Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients",
author="Wolfgang Huber, Uli Mayr, Andreas Umgelter, Michael Franzen, Wolfgang Reindl, Roland M. Schmid, Florian Eckel",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients
%A Wolfgang Huber
%A Uli Mayr
%A Andreas Umgelter
%A Michael Franzen
%A Wolfgang Reindl
%A Roland M. Schmid
%A Florian Eckel
%J Journal of Zhejiang University SCIENCE B
%V 19
%N 7
%P 515-524
%@ 1673-1581
%D 2018
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1700243

T1 - Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients
A1 - Wolfgang Huber
A1 - Uli Mayr
A1 - Andreas Umgelter
A1 - Michael Franzen
A1 - Wolfgang Reindl
A1 - Roland M. Schmid
A1 - Florian Eckel
J0 - Journal of Zhejiang University Science B
VL - 19
IS - 7
SP - 515
EP - 524
%@ 1673-1581
Y1 - 2018
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1700243

Background and objective: stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. Methods: The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. Results: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. Conclusions: The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.




Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Al-Chalabi A, Matevossian E, v Thaden AK, et al., 2013. Evaluation of the Hepa Wash® treatment in pigs with acute liver failure. BMC Gastroenterol, 13:83.

[2]Benes J, Giglio M, Brienza N, et al., 2014a. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care, 18(5):584.

[3]Benes J, Zatloukal J, Kletecka J, et al., 2014b. Respiratory induced dynamic variations of stroke volume and its surrogates as predictors of fluid responsiveness: applicability in the early stages of specific critical states. J Clin Monit Comput, 28(3):225-231.

[4]Biais M, Ehrmann S, Mari A, et al., 2014. Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach. Crit Care, 18(6):587.

[5]Cannesson M, Vallet B, Michard F, 2009. Pulse pressure variation and stroke volume variation: from flying blind to flying right? Br J Anaesth, 103(6):896-899.

[6]Cannesson M, le Manach Y, Hofer CK, et al., 2011. Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach. Anesthesiology, 115(2):231-241.

[7]de Backer D, Taccone FS, Holsten R, et al., 2009. Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology, 110(5):1092-1097.

[8]de Waal EE, Rex S, Kruitwagen CL, et al., 2009. Dynamic preload indicators fail to predict fluid responsiveness in open-chest conditions. Crit Care Med, 37(2):510-515.

[9]Duperret S, Lhuillier F, Piriou V, et al., 2007. Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med, 33(1):163-171.

[10]Goepfert MS, Richter HP, zu Eulenburg C, et al., 2013. Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled trial. Anesthesiology, 119(4):824-836.

[11]Hofkens PJ, Verrijcken A, Merveille K, et al., 2015. Common pitfalls and tips and tricks to get the most out of your transpulmonary thermodilution device: results of a survey and state-of-the-art review. Anaesthesiol Intensive Ther, 47(2):89-116.

[12]Huber W, Umgelter A, Reindl W, et al., 2008. Volume assessment in patients with necrotizing pancreatitis: a comparison of intrathoracic blood volume index, central venous pressure, and hematocrit, and their correlation to cardiac index and extravascular lung water index. Crit Care Med, 36(8):2348-2354.

[13]Huber W, Höllthaler J, Schuster T, et al., 2014. Association between different indexations of extravascular lung water (EVLW) and PaO2/FiO2: a two-center study in 231 patients. PLoS ONE, 9(8):e103854.

[14]Huber W, Kemnitz V, Phillip V, et al., 2015. Outcome prediction, fluid resuscitation, pain management, and antibiotic prophylaxis in severe acute pancreatitis. Intensive Care Med, 41(11):2034-2035.

[15]Huber W, Phillip V, Höllthaler J, et al., 2016a. Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView®: do the same criteria apply as for the PiCCO®? J Zhejiang Univ-Sci B (Biomed & Biotechnol), 17(7):561-567.

[16]Huber W, Fuchs S, Minning A, et al., 2016b. Transpulmonary thermodilution (TPTD) before, during and after sustained low efficiency dialysis (SLED). A prospective study on feasibility of TPTD and prediction of successful fluid removal. PLoS ONE, 11(4):e0153430.

[17]Huber W, Henschel B, Schmid R, et al., 2017. First clinical experience in 14 patients treated with ADVOS: a study on feasibility, safety and efficacy of a new type of albumin dialysis. BMC Gastroenterol, 17(1):32.

[18]Lakhal K, Ehrmann S, Benzekri-Lefèvre D, et al., 2011. Respiratory pulse pressure variation fails to predict fluid responsiveness in acute respiratory distress syndrome. Crit Care, 15(2):R85.

[19]Maguire S, Rinehart J, Vakharia S, et al., 2011. Respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American academic center. Anesth Analg, 112(1):94-96.

[20]Mahjoub Y, Lejeune V, Muller L, et al., 2014. Evaluation of pulse pressure variation validity criteria in critically ill patients: a prospective observational multicentre point-prevalence study. Br J Anaesth, 112(4):681-685.

[21]Mair S, Tschirdewahn J, Götz S, et al., 2016. Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study. J Clin Monit Comput, 31(6):1177-1187.

[22]Michard F, 2005. Volume management using dynamic parameters: the good, the bad, and the ugly. Chest, 128(4):1902-1903.

[23]Michard F, Lopes MR, Auler JO Jr, 2007. Pulse pressure variation: beyond the fluid management of patients with shock. Crit Care, 11(3):131.

[24]Monnet X, Bleibtreu A, Ferré A, et al., 2012. Passive leg-raising and end-expiratory occlusion tests perform better than pulse pressure variation in patients with low respiratory system compliance. Crit Care Med, 40(1):152-157.

[25]Moreau R, Jalan R, Gines P, et al., 2013. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology, 144(7):1426-1437.

[26]Muller L, Louart G, Bousquet PJ, et al., 2010. The influence of the airway driving pressure on pulsed pressure variation as a predictor of fluid responsiveness. Intensive Care Med, 36(3):496-503.

[27]Perel A, 1998. Assessing fluid responsiveness by the systolic pressure variation in mechanically ventilated patients. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology, 89(6):1309-1310.

[28]Phillip V, Saugel B, Ernesti C, et al., 2014. Effects of paracentesis on hemodynamic parameters and respiratory function in critically ill patients. BMC Gastroenterol, 14(1):18.

[29]Preisman S, Kogan S, Berkenstadt H, et al., 2005. Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the respiratory systolic variation test and static preload indicators. Br J Anaesth, 95(6):746-755.

[30]Renner J, Gruenewald M, Quaden R, et al., 2009. Influence of increased intra-abdominal pressure on fluid responsiveness predicted by pulse pressure variation and stroke volume variation in a porcine model. Crit Care Med, 37(2):650-658.

[31]Reuter DA, Felbinger TW, Schmidt C, et al., 2002. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med, 28(4):392-398.

[32]Reuter DA, Goepfert MS, Goresch T, et al., 2005. Assessing fluid responsiveness during open chest conditions. Br J Anaesth, 94(3):318-323.

[33]Rhodes A, Evans LE, Alhazzani W, et al., 2017. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med, 43(3):304-377.

[34]Sakka SG, 2015. Hemodynamic monitoring in the critically ill patient—current status and perspective. Front Med (Lausanne), 2:44.

[35]Saugel B, Phillip V, Gaa J, et al., 2012. Advanced hemodynamic monitoring before and after transjugular intrahepatic portosystemic shunt: implications for selection of patients—a prospective study. Radiology, 262(1):343-352.

[36]Sun Y, Lu ZH, Zhang XS, et al., 2015. The effects of fluid resuscitation according to picco on the early stage of severe acute pancreatitis. Pancreatology, 15(5):497-502.

[37]Trepte CJ, Bachmann KA, Stork JH, et al., 2013. The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis. Intensive Care Med, 39(4):717-726.

[38]Umgelter A, Schmid RM, 2009. Terlipressin for hepatorenal syndrome—what is the role of plasma expansion and hemodynamic monitoring? Z Gastroenterol, 47(3):307-308 (in German).

[39]Umgelter A, Reindl W, Wagner KS, et al., 2008. Effects of plasma expansion with albumin and paracentesis on haemodynamics and kidney function in critically ill cirrhotic patients with tense ascites and hepatorenal syndrome: a prospective uncontrolled trial. Crit Care, 12(1):R4.

[40]Umgelter A, Reindl W, Miedaner M, et al., 2009. Failure of current antibiotic first-line regimens and mortality in hospitalized patients with spontaneous bacterial peritonitis. Infection, 37(1):2-8.

[41]Villar J, Pérez-Méndez L, Kacmarek RM, 2016. The berlin definition met our needs: no. Intensive Care Med, 42(5):648-650.

[42]Wendon J, Bernal W, Willars C, et al., 2011. Critical care and cirrhosis: outcome and benefit. Curr Opin Crit Care, 17(5):533-537.

[43]Yu WQ, Zhang Y, Zhang SY, et al., 2016. Impact of misplaced subclavian vein catheter into jugular vein on transpulmonary thermodilution measurement variables. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 17(1):60-66.

[44]Zhang Z, Lu B, Sheng X, et al., 2011. Accuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis. J Anesth, 25(6):904-916.

[45]Zhang Z, Lu B, Ni H, 2012. Prognostic value of extravascular lung water index in critically ill patients: a systematic review of the literature. J Crit Care, 27(4):420.e1-420.e8.

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