Effect of hypercapnia on pleth variability index during stable propofol: Remifentanil anesthesia

Mousa, Wesam F.

doi:10.4103/1658-354x.115317

Cited by 5 publications

(5 citation statements)

References 25 publications

(22 reference statements)

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“…[ 19 ] Furthermore, it has been reported in the literature that hypercapnia causes a decrease in PVI, so respiratory rate is considered to be important in the accuracy of PVI measurement. [ 20 ] Conflicting data on PVI measurements during spontaneous breathing have been attributed to all these factors. [ 21 ] However, a majority of these studies, which had relatively small study populations with normal respiratory states, used the PLR maneuver, which causes a sudden increase in preload, to assess volume change and fluid unresponsiveness.…”

Section: Discussionmentioning

confidence: 99%

Assessment of pleth variability index in volume changes during ultrafiltration process

Dağar¹,

Uzunosmanoğlu²

2021

Turk J Emerg Med

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OBJECTIVES: Pleth variability index (PVI) has been studied mostly in mechanically ventilated patients, and the role of PVI in predicting volume status and volume changes among spontaneously breathing patients is not clear in the literature. We hypothesized that hemodialysis (HD) can be a valid model for a simulation that can be evaluated the correlation of PVI with fluid changes in various volume states. The aim of this study was to investigate the utility of PVI for assessing volume changes in HD patients who are breathing spontaneously. METHODS: This prospective, observational study included patients aged 18 years or older who had end-stage renal failure and presented for routine HD between December 2019 and January 2020. PVI values were measured before and after HD session. Changes in PVI levels were compared according to the amount of ultrafiltration. RESULTS: A total of sixty patients were included. Mean PVI level before HD (20.7% ± 5%) showed a statistically significant increase to 27.7% ± 6% after HD session ( P < 0.001). According to the amount of fluid removed during HD, the changes in PVI were statistically significant ( P = 0.015). There was a strong correlation between ΔPVI and ultrafiltrated volume ( r = 0.744, P < 0.001). CONCLUSION: The fluid removed by HD caused increase in PVI, and the increase was strongly correlated with the amount of volume change. Bedside monitoring of PVI may provide the clinicians with useful information for monitoring the volume status in critically ill patients with spontaneous breathing.

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Section: Discussionmentioning

confidence: 99%

Assessment of pleth variability index in volume changes during ultrafiltration process

Dağar¹,

Uzunosmanoğlu²

2021

Turk J Emerg Med

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“…[ 16 17 ] Hypercapnia may result from carbon dioxide insufflation and influence PVI. [ 18 ] However, in our study ventilatory conditions were adapted through changes in respiratory rate to maintain end expiratory partial pressure of carbon dioxide level between 35 to 40 mmHg. We observed an increase in the mean arterial pressure during insufflation of the pneumoperitoneum, which is consistent with an increase in sympathetic activity.…”

Section: Discussionmentioning

confidence: 99%

Effect of pneumoperitoneum on dynamic variables of fluid responsiveness (Delta PP and PVI) during Trendelenburg position

et al. 2020

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Background and Aims: Pulse pressure variation (ΔPP) is considered as one of the best predictors of fluid responsiveness in patients under mechanical ventilation. Pleth Variability Index (PVI) has been proposed as a noninvasive alternative. However, pneumoperitoneum has been recently suggested as a limitation to their interpretation. The aim of this study was to compare changes in ΔPP and PVI related to autotransfusion associated with a Trendelenburg maneuver before and during pneumoperitoneum. Methods: 50 patients undergoing elective abdominal laparoscopic surgery were enrolled in this prospective observational study. All patients were equipped with an invasive radial artery catheter and a PVI probe. After obtaining a stable signal with both ΔPP and PVI, baseline values were recorded, before and after head-down tilts of 10°, with or without abdominal insufflation (10-12 mmHg). All measurements were made before any fluid challenge under standardized anaesthesia, while patients were paralyzed and mechanically ventilated with 8 mL/kg tidal volume. Results: Changes in ΔPP and PVI associated with the Trendelenburg maneuver before and after insufflation of the pneumoperitoneum were significantly different ( P < 0.001). In baseline conditions, the Trendelenburg maneuver was associated with a significant decrease in heart rate while mean arterial pressure remained unchanged. Both ΔPP and PVI decreased. After insufflation of the pneumoperitoneum, the Trendelenburg maneuver was associated with a significant decrease in heart rate and ΔPP and an increase in mean arterial pressure while PVI remained unchanged. Conclusion: Pneumoperitoneum did not alter the response of ΔPP to autotransfusion associated with the Trendelenburg maneuver, which was not the case for the PVI. This latter decreased during Trendelenburg maneuver performed alone and remained unchanged during Trendelenburg maneuver performed after insufflation of the pneumoperitoneum.

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“…There can be great individual variations in PI, and several factors may interfere with measurement of PI [23] , [24] , so many previous studies used the pleth variabililty index (PVI) instead of PI to estimate volume status [25] – [27] . Nonetheless, our results suggest that PI can be used to assess changes in microcirculation in the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

Perfusion Index Derived from a Pulse Oximeter Can Detect Changes in Peripheral Microcirculation during Uretero-Renal-Scopy Stone Manipulation (URS-SM)

et al. 2014

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BackgroundThe objective of this study was to test the effect of removal of a ureteral obstruction (renal calculus) from anesthetized patients on the perfusion index (PI), as measured by a pulse oximeter, and on the estimated glomerular filtration rate (eGFR).Patients and MethodsThis prospective study enrolled 113 patients with unilateral ureteral obstructions (kidney stones) who were scheduled for ureteroscopy (URS) laser lithotripsy. One urologist graded patient hydronephrosis before surgery. A pulse oximeter was affixed to each patient's index finger ipsilateral to the intravenous catheter, and a non-invasive blood pressure cuff was placed on the contralateral side. Ipsilateral double J stents and Foley catheters were inserted and left indwelling for 24 h. PI and mean arterial pressure (MAP) were determined at baseline, 5 min after anesthesia, and 10 min after surgery; eGFR was determined at admission, 1 day after surgery, and 14 days after surgery.ResultsPatients with different grades of hydronephrosis had similar age, eGFR, PI, mean arterial pressure (MAP), and heart rate (HR). PI increased significantly in each hydronephrosis group after ureteral stone disintegration. None of the groups had significant post-URS changes in eGFR, although eGFR increased in the grade I hydronephrosis group after 14 days. The percent change of PI correlates significantly with the percent change of MAP, but not with that of eGFR.ConclusionOur results demonstrate that release of a ureteral obstruction leads to a concurrent increase of PI during anesthesia. Measurement of PI may be a valuable tool to monitor the successful release of ureteral obstructions and changes of microcirculation during surgery. There were also increases in eGFR after 14 days, but not immediately after surgery.

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Effect of hypercapnia on pleth variability index during stable propofol: Remifentanil anesthesia

Cited by 5 publications

References 25 publications

Assessment of pleth variability index in volume changes during ultrafiltration process

Assessment of pleth variability index in volume changes during ultrafiltration process

Effect of pneumoperitoneum on dynamic variables of fluid responsiveness (Delta PP and PVI) during Trendelenburg position

Perfusion Index Derived from a Pulse Oximeter Can Detect Changes in Peripheral Microcirculation during Uretero-Renal-Scopy Stone Manipulation (URS-SM)

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