Pleth Variability Index Predicts Fluid Responsiveness in Mechanically Ventilated Adults During General Anesthesia for Noncardiac Surgery

Siswojo, Andy Sisnata; Wong, Daniel M.; Phan, Tuong; Kluger, Roman

doi:10.1053/j.jvca.2014.04.010

Cited by 23 publications

(30 citation statements)

References 36 publications

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“…The ability of PVI to predict fluid responsiveness as measured by SV increase in surgical patients varies among studies, and the same applies to optimal PVI threshold values, which range from 9.5% to 14% . Studies undertaken under stable conditions, after the induction of anaesthesia but before surgery, or using lager tidal volumes and larger fluid volume boluses, are often more positive regarding this predicting ability.…”

Section: Discussionmentioning

confidence: 99%

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

Bahlmann

Hahn

Nilsson

2015

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

“…Pleth Variability Index (PVI) is a non‐invasive pulse oximetry‐derived measure of fluid responsiveness and volaemia . The usefulness of PVI as a guide to fluid therapy during surgery to improve post‐operative outcome has only been studied in two small randomised controlled trials .…”

mentioning

confidence: 99%

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

Bahlmann

Hahn

Nilsson

2015

Acta Anaesthesiol Scand

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“…In these studies, the PVI threshold value was lower than ours. (8,(17)(18)(19) One of the reasons for this diff erence is that in our study, the PVI threshold was calculated by reference to a PPV study. In the other studies, data was collected from patients who were mostly undergoing surgery, whereas data was collected from ICU patients in our study.…”

Section: Discussionmentioning

confidence: 96%

Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents

Karadayi¹,

Karamanlıoğlu²,

Memiş³

et al. 2017

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Introduction. Dynamic tests for predicting fluid responsiveness have generated increased interest in recent years. One of these tests, pulse pressure variation (PPV), is a parameter calculated from respiratory variations of pulse pressure. Another test, pleth variability index (PVI), is based on respiratory variations of the perfusion index and can be measured non-invasively by pulse oximeter. Previous studies have shown that both tests are valuable in determining fluid responsiveness. Methods. In this observational prospective study, our aim was to compare the PVI and PPV in order to identify a convenient tool for determining fluid responsiveness. Our study was performed in a surgical and reanimation intensive care unit. We enrolled one hundred mechanically ventilated adult patients diagnosed with sepsis. Exclusion criteria included brain death, spontaneous breathing, cardiac arrhythmia, and impaired peripheral circulation. We measured the PPV by arterial monitorization and the PVI by using Masimo Radical 7 in the 45° semi-recumbent position (SP) and then 15° Trendelenbug position (TP). We performed correlation and ROC analysis using a >13% fluid responsiveness cut-off value for the PPV and >14% for the PVI. Results. Between the SP and the TP, we did not observe significant decreases in PPV (from 14.17 ± 10.57 to 12.66 ± 9.64; p > 0.05), while we did observe significant decreases in PVI (from 21.91 ± 13.99 to 20.46 ± 14.12; p < 0.05). The PPV fluid responsiveness cut-off value in the SP and TP was 20% (78.95% sensitivity, 77.05% specificity) and 18% (76.67% sensitivity, 72.46%

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“…Feissel et al [36] reported that in septic patients PVI values were significantly higher in responders to hydroxylethyl starch infusion vs. non-responders with significant correlation with the percent changes induced by intervention in aortic velocity-time integral measured using transthoracic echocardiography and PVI at 19% discriminates responders from non-responders with sensitivity, specificity and AUC of 94%, 87% and 0.97, respectively. Siswojo et al [37] reported that pulse oximeter derived from baseline PVI and stroke volume index derived from esophageal Doppler were significantly different between responders and non-responders to fluid intervention and baseline PVI at 10.5% could predict fluid responsiveness with sensitivity and specificity of 88% and 67%, respectively and AUC of 0.84.…”

Section: Discussionmentioning

confidence: 99%

“…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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Pleth Variability Index Predicts Fluid Responsiveness in Mechanically Ventilated Adults During General Anesthesia for Noncardiac Surgery

Cited by 23 publications

References 36 publications

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

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

Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents

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

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