Changes in peripheral perfusion index during intraoperative end-expiratory occlusion tests do not predict the response to fluid administration in patients undergoing lung protective ventilation

Iizuka, Yusuke; Sanui, Masamitsu; Otsuka, Yuji; Yoshinaga, Koichi; Nakatomi, Takeshi; Lefor, Alan Kawarai

doi:10.1007/s00540-021-02988-8

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…In fluid non-responders, PI and SV also decreased; this may be explained by the negative effect of the increase in the intrathoracic pressure during LRM on hemodynamic variables (29,30) and volume status (42), or the degree of vasoplegia due to the anesthetic agents (40,41). Moreover, the decrease in SV in fluid non-responders was similar to that reported by Biais et al (18) and Watanabe et al (17).…”

Section: Correlation Of Pi Lrm Pvi Pi and Ppv T1 With Changes In Svsupporting

confidence: 85%

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Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery

et al. 2022

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IntroductionExcessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes in stroke volume (SV) during lung recruitment maneuver (LRM) can predict FR, and peripheral perfusion index (PI) is related to SV; therefore, we hypothesized that the changes in PI during LRM (ΔPILRM) could predict FR during perioperative period.MethodsPatients who were scheduled for elective non-laparoscopic surgery under general anesthesia with a mechanical ventilator and who required VE (250 mL of crystalloid solution infusion over 10 min) were included. Before VE, LRM was performed by a continuous positive airway pressure of 30 cm H2O for 30 sec; hemodynamic variables with their changes (PI, obtained by pulse oximetry; and ΔPILRM, calculated by using [(PI before LRM—PI after LRM)/PI before LRM]*100) were obtained before and after LRM. After SV (measured by esophageal doppler) and PI had returned to the baseline values, VE was infused, and the values of these variables were recorded again, before and after VE. Fluid responders (Fluid-Res) were defined by an increase in SV ≥10% after VE. Receiver operating characteristic curves of the baseline values and ΔPILRM were constructed and reported as areas under the curve (AUC) with 95% confidence intervals, to predict FR.ResultsOf 32 mechanically ventilated adult patients included, 13 (41%) were in the Fluid-Res group. Before VE and LRM, there were no differences in the mean arterial pressure (MAP), heart rate, SV, and PI between patients in the Fluid-Res and fluid non-responders (Fluid-NonRes) groups. After LRM, SV, MAP, and, PI decreased in both groups, ΔPILRM was greater in the Fluid-Res group than in Fluid-NonRes group (55.2 ± 17.8% vs. 35.3 ± 17.3%, p < 0.001, respectively). After VE, only SV and cardiac index increased in the Fluid-Res group. ΔPILRM had the highest AUC [0.81 (0.66–0.97)] to predict FR with a cut-off value of 40% (sensitivity 92.3%, specificity 73.7%).ConclusionsΔPILRM can be applied to predict FR in mechanical ventilated patients during the perioperative period.

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Section: Correlation Of Pi Lrm Pvi Pi and Ppv T1 With Changes In Svsupporting

confidence: 85%

“…Patients in this study received sevoflurane or desflurane, suggesting that in these patients, PI might have affected various vasoplegia states because of the anesthetic agents. This might explain the unchanged PI values after VE in fluid responders and non-responders (40,41).…”

Section: Correlation Of Pi Lrm Pvi Pi and Ppv T1 With Changes In Svmentioning

confidence: 95%

Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery

et al. 2022

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“…First, our evaluation encompassed three distinct subgroups, whereas the referenced meta-analyses examined two subgroups. Second, two clinical studies that employed a respiratory hold duration of ≥ 30 s were excluded from the mentioned meta-analyses [ 34 , 35 ]. Last, it is noteworthy that these studies reported a notably low operative performance for EEOT [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, two clinical studies that employed a respiratory hold duration of ≥ 30 s were excluded from the mentioned meta-analyses [ 34 , 35 ]. Last, it is noteworthy that these studies reported a notably low operative performance for EEOT [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis

Alvarado Sánchez,

Caicedo Ruiz,

Diaztagle Fernández

et al. 2023

Crit Care

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Introduction Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice. Methods A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative performance of pulse pressure variation, stroke volume variation, passive leg raising (PLR), end-expiratory occlusion test (EEOT), mini-fluid challenge, and tidal volume challenge to predict fluid responsiveness in critically ill and acutely ill surgical patients published between January 1999 and February 2023. Adjusted diagnostic odds ratios (DORs) were calculated by subgroup analyses (inverse variance method) and meta-regression (test of moderators). Variables potentially modifying the operative performance of such predictor tests were classified as technical and clinical. Results A total of 149 studies were included in the analysis. The volume used during fluid loading, the method used to assess variations in macrovascular flow (cardiac output, stroke volume, aortic blood flow, volume‒time integral, etc.) in response to PLR/EEOT, and the apneic time selected during the EEOT were identified as technical variables modifying the operative performance of such fluid responsiveness predictor tests (p < 0.05 for all adjusted vs. unadjusted DORs). In addition, the operative performance of fluid responsiveness predictors was also influenced by clinical variables such as the positive end-expiratory pressure (in the case of EEOT) and the dose of norepinephrine used during the fluid responsiveness assessment for PLR and EEOT (for all adjusted vs. unadjusted DORs). Conclusion Prediction of fluid responsiveness in critically and acutely ill patients is strongly influenced by a number of technical and clinical aspects. Such factors should be considered for individual intervention decisions.

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Assessing fluid responsiveness during spontaneous breathing

Suehiro¹

2022

J Anesth

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Changes in peripheral perfusion index during intraoperative end-expiratory occlusion tests do not predict the response to fluid administration in patients undergoing lung protective ventilation

Cited by 3 publications

References 23 publications

Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery

Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery

Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis

Assessing fluid responsiveness during spontaneous breathing

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