Does the plethysmographic variability index predict fluid responsiveness in mechanically ventilated children? A meta-analysis

Desgranges, François-Pierrick; Evain, Jean-Noël; Neto, Edmundo Pereira de Souza; Raphael, D.R.; Desebbe, Olivier; Chassard, D.

doi:10.1093/bja/aew245

Cited by 23 publications

(15 citation statements)

References 6 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ΔPOP and PVI have been shown to be equally effective for predicting fluid responsiveness in ventilated adults in normal sinus rhythm [20]. Although a study has shown that PVI cannot predict fluid responsiveness [21], a meta-analysis [22] concluded that PVI is a reliable predictor in the pediatric population [15,17,23] (Table 1). The mean threshold for the identification of responders to volume expansion was 14% ± 3%, and the area under the summary ROC curve of PVI was 0.86 [22].…”

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.

show abstract

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

View full text Add to dashboard Cite

show abstract

“…For example, algorithms that use only single features of the pulse waveform (eg, pulse pressure variation) have not consistently predicted fluid responsiveness in critically ill children. 30,31 This study was primarily designed to assess whether using the CRI was feasible and safe in patients undergoing CHS with CPB. Feasibility was operationalized in terms of data missingness because missing data are a known challenge for predictive analytics in health care.…”

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Ehrmann

Leopold

Campbell

et al. 2021

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background: Early warning systems that utilize dense physiologic data and machine learning may aid prediction of decompensation after congenital heart surgery (CHS). The Compensatory Reserve Index (CRI) analyzes changing features of the pulse waveform to predict hemodynamic decompensation in adults, but it has never been studied after CHS. This study sought to understand the feasibility, safety, and potential utility of CRI monitoring after CHS with cardiopulmonary bypass (CPB). Methods: A single-center prospective pilot cohort of patients undergoing pulmonary valve replacement was studied. Compensatory Reserve Index was continuously measured from preoperative baseline through the first 24 postoperative hours. Average CRI values during selected procedural phases were compared between patients with an intensive care unit (ICU) length of stay (LOS) <3 days versus LOS ≥3 days. Results: Twenty-three patients were enrolled. On average, 17,445 (±3,152) CRI data points were collected and 0.33% (±0.40) of data were missing per patient. There were no adverse events related to monitoring. Five (21.7%) patients had an ICU LOS ≥3 days. Compared to the ICU LOS <3 days group, the ICU LOS ≥3 days group had a greater decrease in CRI from baseline to immediately after CPB (−0.3 ± 0.1 vs −0.1 ± 0.2, P = .003) and were less likely to recover to baseline CRI during the monitoring period (20% vs 83%, P = .017). Conclusions: Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.

show abstract

“…Their clinical utility in children is also examined, and recent studies are showing promising results, 17 even in metaanalysis. 18 We assumed that, therefore, there would be one or more indices which have capabilities in predicting hypotension in children. Accordingly, our study aimed to determine which variable best predicted the occurrence of hypotension following intravenous propofol injection in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

“…Several variables, including respiratory variation of pulse oximetry plethysmographic waveform (ΔPOP) 15 and pleth variability index (PVI), 16 have been reported to be reliable noninvasive indices of fluid responsiveness and dehydration in adult surgical patients anesthetized with propofol. Their clinical utility in children is also examined, and recent studies are showing promising results, 17 even in meta‐analysis 18 …”

Section: Introductionmentioning

confidence: 99%

Predicting hypotension during anesthesia: Variation in pulse oximetry plethysmography predicts propofol‐induced hypotension in children

Choi

Jang

et al. 2021

Pediatric Anesthesia

View full text Add to dashboard Cite

Background:The development of hypotension on administration of intravenous propofol is common and independently associated with adverse outcomes. Identifying patients with a high risk for anesthesia-induced hypotension may help anesthesiologists prepare for such an event. Aim:The authors hypothesized that propofol-induced hypotension is predictable by variables related to fluid responsiveness and investigated such variables to determine the factors which can predict hypotensive events.Methods: Patients 3-6 years of age who underwent general were included. Intravenous midazolam 0.1 mg kg −1 was administered as premedication, and preoperative noninvasive blood pressure, heart rate, perfusion index, pleth variability index, and respiratory variation of pulse oximetry plethysmographic waveform were measured. Intravenous propofol 2.5 mg kg −1 was given, and blood pressure was measured 5 times at 1-min intervals. Subjects with significant hypotension (mean blood pressure decrease ≥20%) were allocated to the hypotensive group; those without significant hypotension were allocated to the relatively normotensive group. Results:Of 77 patients, 50 (64.9%) developed significant hypotension. Patients in the hypotensive group exhibited significantly higher respiratory variation of pulse oximetry plethysmographic waveform (mean difference 11 [3.3] [95% confidence interval 4.9-18.1]; p = .001) and higher pleth variability index (mean difference 7.1 [2.8] [95% confidence interval 1.6-12.6]; p = .013) than the normotensive group. The areas under the receiver operating characteristic curve for respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were 0.722 and 0.649, respectively. Conclusion:High preoperative respiratory variation of pulse oximetry plethysmographic waveform and pleth variability index were both independently associated with propofol-induced hypotension in children.

show abstract

Does the plethysmographic variability index predict fluid responsiveness in mechanically ventilated children? A meta-analysis

Cited by 23 publications

References 6 publications

Fluid responsiveness in the pediatric population

Fluid responsiveness in the pediatric population

Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass

Predicting hypotension during anesthesia: Variation in pulse oximetry plethysmography predicts propofol‐induced hypotension in children

Contact Info

Product

Resources

About