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Review
. 2025 Jun 19;29(1):249.
doi: 10.1186/s13054-025-05490-9.

Can we reliably use pulse pressure as a surrogate for stroke volume? Physiological background and potential clinical implications for shock resuscitation

Zbigniew Putowski  1 , Jean-Louis Teboul  2 , Ricardo Castro  3 , Denis Chemla  4 , Jonatan Oras  5 , Sebastian Morales  3 , Eduardo Kattan  6   7 , Glenn Hernandez  3
Affiliations
Review

Can we reliably use pulse pressure as a surrogate for stroke volume? Physiological background and potential clinical implications for shock resuscitation

Zbigniew Putowski et al. Crit Care. .

Abstract

In critically ill patients, early hemodynamic assessment is essential for guiding shock resuscitation. While cardiac output (CO) is a key indicator of circulatory status, its measurement is often limited by technical and practical constraints. This perspective explores the physiological and clinical relevance of pulse pressure (PP) as a potential surrogate for stroke volume (SV), emphasizing its accessibility at the bedside. The paper discusses how factors such as arterial compliance, vascular tone, and pulse wave amplification influence the PP-SV relationship, often complicating interpretation in acute and complex hemodynamic states. It also examines the effects of vasopressors, vascular decoupling, and catheter site on PP measurements, particularly in septic shock. Despite its limitations, the review highlights how peripheral PP, when carefully interpreted, may aid in identifying low SV and guiding early resuscitation strategies.

Keywords: Hemodynamic monitoring; Pulse pressure; Shock resuscitation; Stroke volume.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A schematic representation of pulse wave amplification phenomenon
Fig. 2
Fig. 2
Schematic representation of the main variables that impact the relationship between stroke volume and pulse pressure
Fig. 3
Fig. 3
Vascular decoupling in septic shock [25]
Fig. 4
Fig. 4
(A) Relationship between pulse pressure and the left ventricular outflow tract velocity time integral (LVOT-VTI). (B) Diagnostic accuracy of pulse pressure to predict a low LVOT-VTI (< 14 cm)
See this image and copyright information in PMC

References

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