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

https://doi.org/10.1053/j.jvca.2014.04.010Get rights and content

Objective

To investigate whether the pleth variability index (PVI), derived noninvasively from a pulse oximeter probe, would predict fluid responsiveness in patients undergoing noncardiac surgeries.

Design

A clinical, prospective, observational study.

Setting

Operating room of a tertiary care hospital.

Participants

Twenty-nine adult patients undergoing a range of noncardiac surgeries, requiring general anesthesia, tracheal intubation, and mechanical ventilation.

Interventions

Intravenous volume expansion with 500 mL of colloid following induction of general anesthesia and after a period of hemodynamic stability before the start of surgery.

Measurements and Main Results

Baseline values for PVI and stroke volume index, derived from an esophageal Doppler monitor, were compared with final values after the volume expansion. Patients were classified into fluid responders and nonresponders based on a stroke volume index increase of≥10%. The optimal cut-off value for baseline pleth variability index for predicting fluid responsiveness was determined.

There were 17 responders (59%) to the 500-mL volume expansion. Baseline PVI value was significantly different between responders and nonresponders (16.5±6.4% v 10.3±2.7%; p = 0.004). Receiver operating characteristic analysis demonstrated significant predictive ability of an increase in stroke volume index for PVI with area under the curve of 0.84 (95% confidence interval = 0.69-0.99). The optimal cut-off value for baseline PVI was 10.5%, with a sensitivity of 88% and a specificity of 67%.

Conclusions

Pleth variability index is predictive of fluid responsiveness in adult patients undergoing noncardiac surgery.

Section snippets

Methods

Following approval of the study by the St. Vincent’s Hospital Human Research Ethics Committee-D (Melbourne, Australia) and receipt of written informed consent, 30 adult patients between September 2010 and December 2012 were recruited. Eligible patients included those undergoing noncardiac surgery requiring general anesthesia, tracheal intubation, and mechanical ventilation. Patients with arrhythmias (including atrial fibrillation), ischemic heart disease, cardiac failure, and any

Results

One patient was excluded from the study due to use of a vasopressor after the induction of anesthesia. The remaining 29 patients were investigated, and their demographics are summarized in Table 1. The 500-mL fluid bolus was associated with a significant decrease in HR, an increase in CI, an increase in SVI, an increase in FTc, and a decrease in PVI (Table 2). Using ΔSVI≥10% to define fluid responsiveness, there were 17 responders (59%) to the 500-mL fluid bolus and 12 nonresponders (Table 3).

Discussion

This study showed that baseline PVI was predictive of fluid responsiveness to a 500-mL infusion of colloid in noncardiac patients. A baseline PVI value of 10.5% allowed discrimination between responders and nonresponders with good sensitivity (88%) and specificity (67%). The data support previous studies that demonstrated the ability of PVI to accurately predict fluid responsiveness in cardiac, general surgical, colorectal, and ICU patients.10, 11, 12, 13, 14, 15, 16 In this study, patients

Acknowledgment

This research was funded by the St. Vincent's Hospital (Melbourne) Research Endowment Fund.

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