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Since its first description in 1999 [1], many studies have demonstrated the value of pulse pressure variation (PPV) as a predictor of fluid responsiveness. These studies were pooled together in a recent meta-analysis [2] concluding that PPV predicts fluid responsiveness accurately (sensitivity 88%, specificity 89%), so long as limitations to its use [3,4] are understood and respected (Figure 1).    Figure 1  Most common physiological limitations to the use of pulse pressure variation can be summarized as ‘LIMITS’. HR/RR, heart rate/respiratory rate.

Applicability of pulse pressure variation: how many shades of grey?