Arterial Versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial

Abstract

In the present study, we compared indices of respiratory-induced variation obtained from direct arterial blood pressure measurement with analogous indices obtained from the plethysmogram measured by the pulse oximeter to assess the value of these indices for predicting the cardiac output increase in response to a fluid challenge. Thirty-two fluid challenges were performed in 22 hypotensive patients who were also monitored with a pulmonary artery catheter. Hemodynamic and plethysmographic data were collected before and after intravascular volume expansion. Patients were classified as nonresponders if their cardiac index did not increase by 15% from baseline. Nonresponding patients had both lower arterial pulse variation ([10 +/- 4]% vs [19 +/- 13]%, P = 0.020) and lower plethysmographic pulse variation ([12 +/- 7]% vs [21 +/- 14]%, P = 0.034) when compared with responders. Fluid responsiveness was similarly predicted by arterial and plethysmographic pulse variations (area under ROC curve 0.74 vs 0.72, respectively, P = 0.90) and by arterial and plethysmographic systolic variation (area under ROC curve 0.64 vs 0.72, respectively, P = 0.50). Nonresponders were identified by changes in pulse variation both on arterial and plethysmographic waveform (area under ROC curve 0.80 vs 0.87, respectively, P = 0.40) and by changes in arterial and plethysmographic systolic variations (area under ROC curve 0.84 vs 0.80, respectively, P = 0.76). In the population studied, plethysmographic dynamic indices of respiratory-induced variation were just as useful for predicting fluid responsiveness as the analogous indices derived from direct arterial blood pressure measurement. These plethysmographic indices could provide a noninvasive tool for predicting the cardiac output increase by administering fluid.

Stroke volume variation and pleth variability index to predict fluid responsiveness during resection of primary retroperitoneal tumors in Hans Chinese

“…This study compared the relationship between SVV and PVI intraoperatively, which showed that SVV has a good agreement with PVI. This finding is in agreement with previous studies (7,18), which compared ΔPOP and ΔPP in mechanically ventilated patients under general more than 20% from preoperative values, and completed between 20 to 30 min. Hemodynamic measurements were performed before, and within 30 sec after volume expansion without stimulation, in order to limit changes in vasomotor tone that may have affected PVI value (14).…”

“…Respiratory variation in the ΔPOP waveform amplitude has been studied in mechanically ventilated patients (18,22). Pleth variability index (PVI) (Masimo Co., Irvine, Canada) is a novel algorithm allowing for automated and continuous monitoring of ΔPOP (7).…”

The Effect of Non-Invasive Goal Directed Fluid Administration on Graft Function in Deceased Donor Renal Transplantation: A Pilot Study

“…Plethysomgraphic variability has been shown to predict fluid responsiveness in cardiac [30], general surgical [37] and intensive care patients [28], and goal directed fluid administration protocols directed by PVI have been shown effective at reducing morbidity and length of stay [27] [30] [38]. For dialysis-dependent patients, it is possible that the plethysmographic signal being used to calculate PVI may not be usable.…”

“…Because changes in the amplitude of the pulse oximeter plethysmograph correlate closely with variation in pulse pressure [26] [27]; the plethysmographic variability is able to predict fluid responsiveness in surgical pa-tients [28] [29]. PVI values greater than 13% have been shown to predict fluid responsiveness in surgical patients [30] [31].…”

Hemodynamic instability and fluid responsiveness

“…10,16 Pulse pressure variation (PPV) and systolic pressure variation (SPV)-both derived from analysis of the arterial waveform-, stroke volume variation (SVV), and the variation of the amplitude of the pulse oximeter plethysmographic waveform are predictive of fluid responsiveness. 7,21,22 These techniques use heart-lung interactions during mechanical ventilation. During inspiration, pleural pressure increases, causing a reduction in RV preload and an increase in RV afterload.…”