Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Using pulse pressure variation or stroke volume variation to diagnose right ventricular failure? | Michard et al. Critical Care 2010 14 451 http content 14 6 451 CRITICAL CARE LETTER L_ Using pulse pressure variation or stroke volume variation to diagnose right ventricular failure Frederic Michard1 Guy Richards2 Matthieu Biais3 Marcel Lopes4 and Jose Otavio Auler5 See related research by Daudel etal. http content 14 3 R122 We read with interest two recent studies suggesting that pulse pressure variation PPV is not an accurate predictor of fluid responsiveness in subjects with pulmonary hypertension 1 2 . We agree that PPV and stroke volume variation SVV may not work in patients with right ventricular RV failure. Indeed when PPV and SVV are related to an inspiratory increase in RV afterload and not to a decrease in RV preload they cannot serve as indicators of fluid responsiveness 3 . This is indeed a limitation but can also be seen as useful information for clinicians who do not have an echo probe on the ends of their fingers. PPV and SVV are now available on virtually all bedside and hemodynamic monitors. These parameters have been shown to be very useful for predicting fluid responsiveness in many patients with an arterial line who are mechanically ventilated 3 . When part of goal-directed strategies these parameters have also been shown able to improve patient outcome 4 5 . As a result PPV and SVV are now widely used by clinicians in the decision-making process regarding fluid therapy. In this context the lack of response to a volume load while PPV or SVV is high should be seen as an indicator of RV dysfunction and should trigger an echocardiographic evaluation to confirm the diagnosis and to understand the underlying mechanisms. In other words we believe PPV and SVV may actually help clinicians to diagnose quickly and treat properly shock states related to RV failure Authors response Stephan M Jakob and Jukka Takala We agree with Michard and colleagues that failure to respond to fluid loading despite PPV may indicate RV failure.
