Arterial pressure wave: Starling

Arterial pressure waveform can be utilized for goal-directed fluid management as it provides a representation of where the patient lies on the Starling curve. The Frank-Starling curve is an illustration that compares left-ventricular diastolic pressures or preload on the X-axis to stroke volume on the Y-axis. The farther out on the Starling curve, i.e. higher up on the X-axis, the less change in stroke volume is seen with the addition of fluid (less volume responsive).

An arterial pressure waveform that depicts frequent oscillations or high pulse pressure variation indicates variability in the LVEDP with each cardiac cycle. Higher pulse pressure variation is associated with being lower on the Starling Curve and the patient would thus have a positive response from a fluid bolus.