Original Research ArticlePleth Variability Index Predicts Fluid Responsiveness in Mechanically Ventilated Adults During General Anesthesia for 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.
References (37)
Arterial pressure variation and goal-directed fluid therapy
J Cardiothorac Vasc Anesth
(2010)- et al.
Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares
Chest
(2008) - et al.
Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre
Br J Anaesth
(2008) - et al.
Improving perioperative outcomes: Fluid optimization with the esophageal Doppler monitor, a metaanalysis and review
J Am Coll Surg
(2008) - et al.
Evaluation of corrected flow time in esophageal Doppler as a predictor of fluid responsiveness
Br J Anaesth
(2007) - et al.
Randomized controlled trial to investigate influence of the fluid challenge on duration of hospital stay and perioperative morbidity in patients with hip fractures
Br J Anaesth
(2002) - et al.
Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness
Br J Anaesth
(2011) - et al.
Effects of intravenous fluid restriction on postoperative complications: Comparison of two perioperative fluid regimens: A randomized assessor-blinded multicenter trial
Ann Surg
(2003) - et al.
Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature
Crit Care Med
(2009) - et al.
Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure
Am J Respir Crit Care Med
(2000)