Pleth variability index and fluid management practices: a multicenter service evaluation

Abstract

Objectives The introduction of a new technology has the potential to modify clinical practices, especially if easy to use, reliable and non-invasive. This observational before/after multicenter service evaluation compares fluid management practices during surgery (with fluids volumes as primary outcome), and clinical outcomes (secondary outcomes) before and after the introduction of the Pleth Variability Index (PVI), a non-invasive fluid responsiveness monitoring. Results In five centers, 23 anesthesiologists participated during a 2-years period. Eighty-eight procedures were included. Median fluid volumes infused during surgery were similar before and after PVI introduction (respectively, 1000 ml [interquartile range 25–75 [750–1700] and 1000 ml [750–2000]). The follow-up was complete for 60 from these and outcomes were similar. No detectable change in the fluid management was observed after the introduction of a new technology in low to moderate risk surgery. These results suggest that the introduction of a new technology should be associated with an implementation strategy if it is intended to be associated with changes in clinical practice.

Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients

“…In the PVI group, the initial lactate value was 14 We compared the lactate levels at 6 h after the surgery which is at a different timing than the previous study and could not find a significant difference. Increasing the number of ABG would add to the cost of the study.…”

“…Our results agree to the conclusion of Forget et al, who reported a significant decrease in crystalloid (P=0.004) and total fluid (P=0.049). 14 Thus, the use of the non-invasive PVI appears to be better than the traditional hemodynamic parameters such as CVP in predicting fluid responsiveness. These data support previous work showing that plethysmography variability can predict fluid responsiveness in cardiac, general surgical, and intensive care patients.…”