Reliability of pleth variability index in predicting preload responsiveness of mechanically ventilated patients under various conditions: a systematic review and meta-analysis

Abstract

Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and update of the meta-analysis needs to be completed. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The area under the curve (AUC) of receiver operating characteristics (ROC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of the without undergoing surgery subgroup (AUC =0.86, Youden index =0.65) and ICU subgroup (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can play an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Patients who are expanded with colloid and patients who undergoing cardiac surgery may be more suitable for PVI.

The Safety Assessment of Irrigation Fluid Management for Shoulder Arthroscopy and Its Effect on Postoperative Efficacy

“…Pulse pressure variation (PPV) is an index for evaluating the volume status of patients undergoing mechanical ventilation under general anesthesia and judging their volume responsiveness based on the mechanism of the cardiopulmonary interaction. It is a dynamic index and has recently been viewed for the commonly used indicators of anesthesia volume management (21,22), Broch O et al believe that it is morestronger to use the PPV to predict uid reactivity withhigher accuracy than using static indicators such as CVP and CI(18). Therefore, PPV has great clinical value in predicting volume responsiveness.…”

Assessment of neonatal perfusion

“…An increase in stroke volume variation (SVV) and thoracic fluid content (TFC) has been utilized in pediatric populations as a marker for preload, but there is paucity of data in the newborn population [10]. Similarly, the Pleth-variability index (PVi) using the Masimo® pulse oximeter has been described in adults as a marker to assess preload status [11]. It is calculated from (Pi max -Pi min ) x 100/Pi max .…”