ArticleCritical care (London, England)2014
Clinical relevance of pulse pressure variations for predicting fluid responsiveness in mechanically ventilated intensive care unit patients: the grey zone approach.
Article in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 57 papers, 6 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Association of Respiratory Variation of Superior Vena Cava in Transthoracic View and Fluid Responsiveness in Critically Ill Patients
Tidal Volume Challenge to Assess Volume Responsiveness with Dynamic Preload Indices During Surgery: a Prospective Study
Who cites it
57 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- ESICM guidelines on circulatory shock and hemodynamic monitoring 2025.Intensive care medicine · 2025Guideline
- Reliability of pulse pressure and stroke volume variation in assessing fluid responsiveness in the operating room: a metanalysis and a metaregression.Critical care (London, England) · 2023Pooled it
- Pooled it
- Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness.Critical care (London, England) · 2019Pooled it
- Is goal-directed fluid therapy based on dynamic variables alone sufficient to improve clinical outcomes among patients undergoing surgery? A meta-analysis.Critical care (London, England) · 2018Pooled it
- Applicability of respiratory variations in stroke volume and its surrogates for dynamic fluid responsiveness prediction in critically ill patients: a systematic review of the prevalence of required conditions.Revista Brasileira de terapia intensivaPooled it
- Change in cardiac output during Trendelenburg maneuver is a reliable predictor of fluid responsiveness in patients with acute respiratory distress syndrome in the prone position under protective ventilation.Critical care (London, England) · 2017Trial
- Comparison of the change in carotid corrected flow time and stroke volume variation for assessing volume responsiveness in general anesthesia patients: a prospective, observational study.Journal of clinical monitoring and computing · 2026Observational
- Fluid management methods for severely burned patients: a narrative review.Journal of clinical monitoring and computing · 2026Review
- Article
- The time course of fluid responsiveness.Annals of intensive care · 2026Review
- Detection of fluid responsiveness by changes of perfusion index and pleth-variability index during passive leg raising in spontaneously breathing post-surgical patients: a prospective interventional study.Journal of clinical monitoring and computing · 2025Article
- Machine learning based CAGIB score predicts in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding.NPJ digital medicine · 2025Article
- Central venous pressure: current uses and prospects for an old parameter.Intensive care medicine · 2025Article
- Assessing fluid responsiveness by using functional hemodynamic tests in critically ill patients: a narrative review and a profile-based clinical guide.Journal of clinical monitoring and computing · 2025Review
- Fluid management strategies in critically ill patients with ARDS: a narrative review.European journal of medical research · 2025Review
- Improved Prediction of Fluid Responsiveness in Ventilated Patients With Low Tidal Volume: The Role of Preload Variation.Critical care explorations · 2025Article
- Article
- Assessment of fluid responsiveness after tidal volume challenge in renal transplant recipients: a nonrandomized prospective interventional study.Clinical transplantation and research · 2024Article
- Can central venous pressure help identify acute right ventricular dysfunction in mechanically ventilated critically ill patients?Annals of intensive care · 2024Article
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Authors and funding
14 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionPulse pressure variation (PPV) has been shown to predict fluid responsiveness in ventilated intensive care unit (ICU) patients. The present study was aimed at assessing the diagnostic accuracy of PPV for prediction of fluid responsiveness by using the grey zone approach in a large population.
methodsThe study pooled data of 556 patients from nine French ICUs. Hemodynamic (PPV, central venous pressure (CVP) and cardiac output) and ventilator variables were recorded. Responders were defined as patients increasing their stroke volume more than or equal to 15% after fluid challenge. The receiver operating characteristic (ROC) curve and grey zone were defined for PPV. The grey zone was evaluated according to the risk of fluid infusion in hypoxemic patients.
resultsFluid challenge led to increased stroke volume more than or equal to 15% in 267 patients (48%). The areas under the ROC curve of PPV and CVP were 0.73 (95% confidence interval (CI): 0.68 to 0.77) and 0.64 (95% CI 0.59 to 0.70), respectively (P<0.001). A grey zone of 4 to 17% (62% of patients) was found for PPV. A tidal volume more than or equal to 8 ml.kg(-1) and a driving pressure (plateau pressure - PEEP) more than 20 cmH2O significantly improved the area under the ROC curve for PPV. When taking into account the risk of fluid infusion, the grey zone for PPV was 2 to 13%.
conclusionsIn ventilated ICU patients, PPV values between 4 and 17%, encountered in 62% patients exhibiting validity prerequisites, did not predict fluid responsiveness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.