Respiratory failure & ventilation
Does tidal volume challenge improve the feasibility of pulse pressure variation in patients mechanically ventilated at low tidal volumes? A systematic review and meta-analysis
Authors' conclusion
TVC is capable to help PPV overcome limitations in low tidal volume ventilation, wherever in ICU or surgery. The accuracy of TVC is not influenced by reduced lung compliance, moderate PEEP and measurement tools
Study context
- Population
- Patients mechanically ventilated at low tidal volumes457 measurements
- Participants
- 429 participants · 10 studies
- Comparison
- PPV change after tidal volume challenge vs PPV alone
- Outcome
- Predictive performance of PPV change after TVC (SROC, pooled sensitivity and specificity)
Methodological detailssubgroup analyses
- Subgroup analyses
Pooled result
As reported in the abstract
| Group | Value | SROC AUC | Pooled sensitivity | Pooled specificity |
|---|---|---|---|---|
| PPV change after tidal volume challenge (TVC) | mean AUROC 0.89 (SD 0.10) | 0.96 (95% CI 0.94, 0.97) | 0.92 (95% CI 0.83, 0.96) | 0.88 (95% CI 0.76, 0.94) |
| PPV | mean AUROC 0.69 (SD 0.13) |
Value
PPV change after tidal volume challenge (TVC)mean AUROC 0.89 (SD 0.10)
PPVmean AUROC 0.69 (SD 0.13)
SROC AUC
PPV change after tidal volume challenge (TVC)0.96 (95% CI 0.94, 0.97)
PPV— not stated in the abstract
Pooled sensitivity
PPV change after tidal volume challenge (TVC)0.92 (95% CI 0.83, 0.96)
PPV— not stated in the abstract
Pooled specificity
PPV change after tidal volume challenge (TVC)0.88 (95% CI 0.76, 0.94)
PPV— not stated in the abstract
Further pooled results
Cutoff values of PPV change
- △PPV mean cutoff
- 2.4%
- △PPV median cutoff
- 2%
- △PPV% mean cutoff
- 25%
- △PPV% median cutoff
- 22.5%
SROC AUC of PPV change by subgroup (subgroup)
- ICU
- 0.95 (95%0.93, 0.97)
- Supine or semi-recumbent position
- 0.95 (95% CI 0.92, 0.96)
- Lung compliance <30 cm H2O
- 0.96 (95% CI 0.94, 0.97)
- Moderate positive end-expiratory pressure (PEEP)
- 0.95 (95% CI 0.93, 0.97)
- Devices without transpulmonary thermodilution
- 0.94 (95% CI 0.92, 0.96)
Lowest AUROCs of PPV change (subgroup)
- Prone position
- 0.59 (95% CI 0.31, 0.88)
- Spontaneous breathing activity
- 0.73 (95% CI 0.60, 0.84)
Original publication
Does tidal volume challenge improve the feasibility of pulse pressure variation in patients mechanically ventilated at low tidal volumes? A systematic review and meta-analysis. Crit Care. Published 2 February 2023. doi:10.
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