The focus of Journal CME is to educate readers on current developments in the science and clinical practice of anesthesiology.

Read the article by by Cannesson et al. entitled “Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: A ‘gray zone’ approach,” on page 231 and the accompanying editorial by De Hert entitled “Assessment of fluid responsiveness: Insights in a ‘gray zone,’ ” on page 229 of this issue.

In mechanically ventilated patients undergoing general anesthesia, the best predictors of fluid responsiveness are respiratory arterial pulse pressure variations (PPV). However, previous studies on the subject were conducted using a small number of patients and determined a single cutoff point to make clinical discrimination. In contrast, the goal of the authors of the present study was to test the predictive value of PPV in a large, multicenter study and to express it using a gray zone approach. The gray zone approach identified a range of PPV values (between 9% and 13%) for which fluid responsiveness could not be predicted reliably; such values were seen in 24% of patients.

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