ArticlePloS one2026
Pulse pressure variation demonstrates dose-dependent response to volume resuscitation in pediatric craniosynostosis repair.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundRestoring intravascular volume in the face of hemorrhagic blood loss is a fundamental skill critical to the practice of anesthesiology. Predictors of fluid responsiveness in pediatric patients remain a challenge. Pulse pressure variation (PPV) is a valuable predictor of volume responsiveness in adults, but the utility in pediatric resuscitation remains controversial. Surgical correction of craniosynostosis occurs early in childhood and is commonly associated with significant, rapid blood loss intraoperatively. This study examines the relationship between blood product boluses with PPV and mean arterial pressure (MAP).
methodsA retrospective, single center analysis of pediatric patients undergoing open cranial vault expansion over a four-year period was performed. Descriptive variables, blood product administrations, MAP, and PPV were extracted and analyzed using a linear mixed-effects model to characterize the association between blood product administration with MAP and PPV. To account for non-independence of repeated measures, the patient was modeled as a random effect with bolus events nested within the patient variable.
resultsA total of 798 bolus events from 111 patients met criteria. Patient ages ranged from 1-23 months (mean 10 months, SD 4.6 months). Transfusion of blood products was associated with increase in MAP by 1.60 mmHg [95% CI: 1.14, 2.06] and reduction in PPV by 0.82 percentage points [95% CI: 0.59, 1.06] (both p < 0.001). Notably, the magnitude of PPV reduction was dose-dependent: for each additional 10 mL/kg administered, post-bolus PPV decreased by an additional 0.4 percentage points [95% CI: 0.02, 0.07] (p = 0.002). In contrast, the MAP increase was not volume-dependent (interaction p = 0.918).
conclusionThis retrospective analysis of pediatric craniosynostosis repair cases at a single institution suggests that PPV is associated with a dose-dependent response to volume resuscitation, while MAP showed a fixed-magnitude response. These preliminary findings warrant further study in multicenter validity.
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