Agreement between Pleth Variability Index and oesophageal Doppler to predict fluid responsiveness

Bahlmann, Hans; Hahn, Robert G.; Nilsson, Lena

doi:10.1111/aas.12632

Cited by 16 publications

(23 citation statements)

References 23 publications

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“…From the remaining 146 patients, a preoperative urine sample had been obtained from 112. The results from the first half of this trial have been published elsewhere and show that the amount of fluid infused in the two groups was quite similar throughout the study (Bahlmann et al 2016 ).…”

Section: Methodssupporting

confidence: 53%

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Preoperative fluid retention increases blood loss during major open abdominal surgery

2017

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BackgroundQuantification of renal fluid conservation is possible by urine analysis, and the results can indicate dehydration. The present report sought to determine whether this fluid retention correlates with fluid requirements during major abdominal surgeries that have estimated operating times ≥ 2 h.MethodsUrine colour, specific weight, osmolality and creatinine concentration were used to calculate a composite “fluid retention index” (FRI) in 97 patients prior to major abdominal surgery. Goal-directed fluid volume optimization, with hydroxyethyl starch supplemented with a background administration of crystalloid fluid, was used.ResultsThe median preoperative FRI was 3.0. Fluid retention, considered as present when FRI ≥ 3.5, was found in 37% of the patients. Fluid retention was followed by a significantly larger blood loss (+ 125%; 450 vs. 200 ml), higher haemorrhage rate (+ 41%; 123 vs. 87 ml/h) and greater need for both colloid (+ 43%; 1.43 vs. 1.00 l) and crystalloid (+ 18%; 1.28 vs. 1.08 l) fluids. Despite the larger blood loss, the total fluid balance was more positive after surgery in the dehydrated patients (+ 26%; 1.91 vs. 1.51 l; P < 0.02).ConclusionsPreoperative fluid retention, as detected in a urine sample, was associated with a greater blood loss and a more positive fluid balance during major abdominal surgery.Trial registration ClinicalTrials.gov, NCT01458678 Electronic supplementary materialThe online version of this article (doi:10.1186/s13741-017-0068-1) contains supplementary material, which is available to authorized users.

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Section: Methodssupporting

confidence: 53%

“…For the alternative method, a fluid bolus was given when the Pleth Variability Index exceeded 9%. Details of these measurements have been presented elsewhere (Bahlmann et al 2016 ).…”

Section: Methodsmentioning

confidence: 99%

Preoperative fluid retention increases blood loss during major open abdominal surgery

2017

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“…Primary outcome measures were the amount of colloid used for optimization of fluid status and the concordance between different methods for assessing preoperative dehydration. These results have been published elsewhere [ 9 , 10 ] and included the first half of the study cohort (75 patients). The present article focuses on clinical outcome in the whole cohort of 150 patients, as quantified by number of postoperative complications up to 30 days after surgery and length of hospital stay, both of which were designated as secondary outcome measures in the study protocol.…”

Section: Introductionmentioning

confidence: 99%

Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial

2018

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BackgroundThe impact of Goal Directed Fluid Therapy (GDFT) based on the non-invasive Pleth Variability Index (PVI) on clinical outcome after abdominal surgery has only sparingly been explored. The purpose of this study was to compare the effect of intraoperative GDFT guided by PVI to a control group using esophageal Doppler on the incidence of complications and length of hospital stay after major abdominal surgery. We hypothesized that there would be no difference between the groups.MethodsThis was a randomized controlled trial in a Swedish university hospital between November 2011 and January 2015; 150 patients scheduled for open abdominal surgery lasting 2 h or more were included. Exclusion criteria included hepatic resection or severe cardiac arrhythmia. The patients were randomized 1:1 to either the intervention group or the control group. The intervention group received intraoperative GDFT by administering fluid boluses of 3 ml/kg tetrastarch aiming at a PVI value below 10%, while GDFT in the control group aimed for optimization of stroke volume as assessed with esophageal Doppler. Blinded observers assessed complications until postoperative day 30 using pre-defined definitions, as well as length of hospital stay.ResultsOne hundred and-fifty patients were randomized and 146 patients were available for the final data analysis. Median duration of surgery was 3 h. A total of 64 complications occurred in the PVI group (N = 74) and 70 in the Doppler group (N = 72) (p = 0.93). Median (IQR) length of stay was 8.0 (8.0) days in the PVI group and 8.0 (9.5) in the Doppler group (P = 0.57).ConclusionsNo difference in clinical outcome, as defined by number of postoperative complications, and length of hospital stay, was found when goal directed fluid therapy was applied using PVI as an alternative to esophageal Doppler. PVI appears to be an acceptable alternative to esophageal Doppler for goal directed fluid therapy during major open abdominal surgery.Trial registrationClinicaltrials.gov NCT01458678. Date of first registration October 20, 2011.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0579-4) contains supplementary material, which is available to authorized users.

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“…On contrary, Bahlmann et al [40] found pulse oximetric PVI-and esophageal Doppler-based stroke volume optimizations agreed poorly and did not affect the amount of fluid Table 4 Laboratory data reported at ICU admission and after fluid resuscitation of studied patients categorized according to survival.…”

Section: Discussionmentioning

confidence: 93%

“…administered, and none of both algorithms showed a good ability to predict fluid responsiveness and concluded that these results do not support the fluid responsiveness concept. These discrepancies concerning predictability of PVI to fluid responsiveness could be attributed to the fact that the concept is still recently involved in researches and not examined in wider scale comparative studies and to the variability of choice of the comparative cutoff point for PVI [23,36,37,40] and the choice of counter comparative method [36,37,40].…”

Section: Discussionmentioning

confidence: 99%

Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients

Mohamed

Essam

2016

Egyptian Journal of Anaesthesia

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Objectives: Evaluation of fluid responsiveness of septic shock patients admitted to surgical ICU and the predictability of non-invasive monitoring and estimated lactate/pyruvate (L/P) ratio for survival of these patients. Patients and methods: The study included 58 septic shocked patients admitted and managed at surgical ICU. After non-invasive determination of baseline hemodynamic data and calculation of shock index (SI-0) and Pleth variability index (PVI-0), all patients received intravenous colloid infusion followed 15-min later by non-invasive re-evaluation for SI-15 and PVI-15. Blood samples were obtained for estimation of blood lactate and pyruvate levels at admission (BLL-0 and BPL-0) and 12-h after fluid resuscitation (BLL-12 and BPL-12) and L/P ratio was calculated. All patients were managed according to the Surviving Sepsis Campaign guidelines and followed up for ICU mortality rate (MR). Results: ICU stay MR was 20.7%. Survival showed negative significant correlation with PVI, L/P ratio and BLL, while it showed positive significant correlation with BPL. Receiver Operating Characteristic (ROC) curve analysis defined baseline and persistently low PVI, high BLL and L/P ratio as significant sensitive predictors for MR, while elevated BPL-12 as significant specific predictor for survival. Regression analysis defined persistently elevated L/P ratio as the highly significant specific predictor, while persistently disturbed SI and PVI could predict mortality as screening tests. Odds ratio for mortality at BLL-0 of >2 mmol/L was 0.0321 (95% CI: 0.0037-0.2755), while it was 4.1111 (95% CI: 1.0702-15.792) at BLL-0 >4 mmol/L. Conclusion: After fluid resuscitation and hemodynamic stability, persistently elevated BLL could predict mortality, while elevated BPL could predict survival of septic shock patients. Continuous non-invasive evaluation of fluid responsiveness judged by PVI and SI could provide sensitive

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Agreement between Pleth Variability Index and oesophageal Doppler to predict fluid responsiveness

Abstract: PVI- and Doppler-based stroke volume optimisations agreed poorly, which did not affect the amount of fluid administered. None of the algorithms showed a good ability to predict fluid responsiveness. Our results do not support the fluid responsiveness concept.

Cited by 16 publications

References 23 publications

Preoperative fluid retention increases blood loss during major open abdominal surgery

Preoperative fluid retention increases blood loss during major open abdominal surgery

Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial

Disturbed fluid responsiveness and lactate/pyruvate ratio as predictors for mortality of septic shock patients

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