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An equally important aspect is however to also avoid volume-overload. This accounts particularly when capillary leakage is present and volume-overload will promote impairment of microcirculatory blood flow. The aim of this study was to evaluate, whether an impairment of intestinal microcirculation caused by volume-load potentially can be predicted using pulse pressure variation in an experimental model of ischemia\/reperfusion injury. The study was designed as a prospective explorative large animal pilot study. The study was performed in 8 anesthetized domestic pigs (German landrace). Ischemia\/reperfusion was induced during aortic surgery. 6\u00a0h after ischemia\/reperfusion-injury measurements were performed during 4 consecutive volume-loading-steps, each consisting of 6\u00a0ml\u00a0kg<jats:sup>\u22121<\/jats:sup> bodyweight<jats:sup>\u22121<\/jats:sup>. Mean microcirculatory blood flow (mean Flux) of the ileum was measured using direct laser-speckle-contrast-imaging. Receiver operating characteristic analysis was performed to determine the ability of pulse pressure variation to predict a decrease in microcirculation. A reduction of \u2265\u200910% mean Flux was considered a relevant decrease. After ischemia\u2013reperfusion, volume-loading-steps led to a significant increase of cardiac output as well as mean arterial pressure, while pulse pressure variation and mean Flux were significantly reduced (Pairwise comparison ischemia\/reperfusion-injury vs. volume loading step no. 4): cardiac output (l min<jats:sup>\u22121<\/jats:sup>) 1.68 (1.02\u20132.35) versus 2.84 (2.15\u20133.53), <jats:italic>p<\/jats:italic>\u2009=\u20090.002, mean arterial pressure (mmHg) 29.89 (21.65\u201338.12) versus 52.34 (43.55\u201361.14), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, pulse pressure variation (%) 24.84 (17.45\u201332.22) versus 9.59 (1.68\u201317.49), <jats:italic>p<\/jats:italic>\u2009=\u20090.004, mean Flux (p.u.) 414.95 (295.18\u2013534.72) versus 327.21 (206.95\u2013447.48), <jats:italic>p<\/jats:italic>\u2009=\u20090.006. Receiver operating characteristic analysis revealed an area under the curve of 0.88 (CI 95% 0.73\u20131.00; <jats:italic>p<\/jats:italic> value\u2009&lt;\u20090.001) for pulse pressure variation for predicting a decrease of microcirculatory blood flow. The results of our study show that pulse pressure variation does have the potential to predict decreases of intestinal microcirculatory blood flow due to volume-load after ischemia\/reperfusion-injury. This should encourage further translational research and might help to prevent microcirculatory impairment due to excessive fluid resuscitation and to guide fluid therapy in the future.<\/jats:p>","DOI":"10.1038\/s41598-021-88458-3","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T10:04:55Z","timestamp":1619604295000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The use of pulse pressure variation for predicting impairment of microcirculatory blood flow"],"prefix":"10.1038","volume":"11","author":[{"given":"Christoph R.","family":"Behem","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael F.","family":"Graessler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Till","family":"Friedheim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahel","family":"Kluttig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans O.","family":"Pinnschmidt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Dupr\u00e9e","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. 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