Comparison of stroke volume variation with pulse pressure variation as a diagnostic indicator of fluid responsiveness in mechanically ventilated critically ill patients

ABSTRACT

To compare the diagnostic accuracy of stroke volume variation [SVV] and pulse pressure variation [PPV] in studies that examined both parameters in the same patient population. Literature search was conducted in PubMed, EMBASE, CINAHL, and Google Scholar. Receiver operator characteristic [ROC] curves were examined, and summary ROC curves were plotted. The study was conducted from January to July 2013 in The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China. The meta-analysis of 19 studies published during the years 2005 and 2013 revealed a high degree of diagnostic accuracy of both SVV and PPV in predicting fluid responsiveness. The sensitivity and specificity of both the parameters were observed above 80% in a heterogeneous group of over 850 patients of which 55% responded to fluid challenge. The following values along with 95% confidence interval were noticed SVV - sensitivity 82 [59-93%] and specificity 84 [62-95%], PPV - sensitivity 84 [62-95%] and specificity 83 [58-94%]. Area under the curve values obtained in the pooled analysis were 0.84 [0.79-0.89] for SVV, and 0.88 [0.84-0.92] for PPV. Both SVV and PPV exhibit a high degree of diagnostic accuracy in predicting the success or failure of a fluid challenge in hemodynamically unstable critically ill patients under controlled mechanical ventilation