Pleth variability index predicts fluid responsiveness in critically ill patients*

Loupec, Thibault; Nanadoumgar, Hodanou; Frasca, Denis; Petitpas, Franck; Laksiri, Leila; Baudouin, Didier; Debaene, B.; Dahyot‐Fizelier, Claire; Mimoz, Olivier

doi:10.1097/ccm.0b013e3181ffde1c

Cited by 95 publications

(100 citation statements)

References 44 publications

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“…Studies have shown the usefulness of this noninvasive dynamic parameter in mechanically ventilated patients in the operating room and in the intensive care unit (ICU). 6,10,19 Conversely, other studies have concluded that PVI was of limited value in predicting fluid responsiveness in laparoscopic surgery 20 and in the ICU setting, respectively. 21 Several observations have shown the limitations of this parameter.…”

Section: Discussionmentioning

confidence: 97%

“…In previous studies, the PVI has been labelled a predictor of fluid responsiveness [5][6][7] however, it is unclear whether this parameter can also be used in patients with nerve blocks. It is possible that the application of local anesthetics might result in changes in the state of peripheral perfusion, which could influence the accuracy of PVI to predict changes in preload reliably following volume expansion.…”

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters

Sebastiani

Philippi

Boehme

et al. 2012

Can J Anesth/J Can Anesth

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Background Interscalene nerve blocks provide adequate analgesia, but there are no objective criteria for early assessment of correct catheter placement. In the present study, pulse oximetry technology was used to evaluate changes in the perfusion index (PI) in both blocked and unblocked arms, and changes in the plethysmographic variability index (PVI) were evaluated once mechanical ventilation was instituted. Methods The PI and PVI values were assessed using a Radical-7 TM finger pulse oximetry device (Masimo Corp., Irvine, CA, USA) in both arms of 30 orthopedic patients who received an interscalene catheter at least 25 min before induction of general anesthesia. Data were evaluated at baseline, on application of local anesthetics; five, ten, and 15 min after onset of interscalene nerve blocks; after induction of general anesthesia; before and after a 500 mL colloid fluid challenge; and five minutes thereafter.

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Section: Discussionmentioning

confidence: 97%

Section: Résumémentioning

confidence: 99%

Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters

Sebastiani

Philippi

Boehme

et al. 2012

Can J Anesth/J Can Anesth

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show abstract

“…[54][55][56][57][58] Solus-Biguenet et al, for instance, found a weak correlation of 0.29. 54 Nevertheless, despite this weak correlation, the majority of fluid responsiveness studies suggest that the respiratory variation in the PPG tracing is predictive of the hemodynamic response to fluid loading, [59][60][61][62][63] although this finding is not universal. 64,65 Surprisingly, despite the fact that the physiologic meaning of arterial respiratory variation has been understood for decades, extrapolation to the PPG waveform was completely missed by the manufacturers of pulse oximeters who considered this information ''noise'' and filtered it out through the application of high-pass filters.…”

Section: Fluid Responsivenessmentioning

confidence: 86%

Advances in photoplethysmography: beyond arterial oxygen saturation

Bartels

Thiele

2015

Can J Anesth/J Can Anesth

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Purpose Photoplethysmography permits continuous measurement of heart rate and peripheral oxygen saturation and has been widely used to inform clinical decisions. Recently, a myriad of noninvasive hemodynamic monitoring devices using this same technology have been increasingly available. This narrative review aims to summarize the principles that form the basis for the function of these devices as well as to comment on trials evaluating their accuracy and clinical application. Principal findings Advanced monitoring devices extend photoplethysmography technology beyond measuring oxygen concentration and heart rate. Quantification of respiratory variation of the photoplethysmographic waveform reflects respiratory variation of the arterial pressure waveform and can be used to gauge volume responsiveness. Both the volume-clamp and physiocal techniques are extensions of conventional photoplethysmography and permit continuous measurement of finger arterial blood pressure. Finger arterial pressure waveforms can subsequently inform estimations of cardiac output. Conclusions Although respiratory variations of the plethysmographic waveform correlate only modestly with the arterial blood pressure waveform, fluid responsiveness can be relatively consistently assessed using both approaches. Continuous blood pressure measurements obtained using the volume-clamp technique may be as accurate as conventional brachial noninvasive blood pressure measurements. Most importantly, clinical comparative effectiveness studies are still needed in order to determine if these technologies can be translated into improvement of relevant patient outcomes. RésuméObjectif La photopléthysmographie permet la mesure continue de la fréquence cardiaque et de la saturation en oxygène périphérique, et elle est largement utilisée pour les prises de décisions cliniques. Depuis peu, un très grand nombre de dispositifs non invasifs de surveillance hémodynamique utilisant la même technologie envahit le marché. Cette synthèse narrative vise à résumer les principes à la base du fonctionnement de ces dispositifs et à commenter les essais évaluant leur exactitude ainsi que leurs applications cliniques. Constatations principales Les dispositifs de surveillance avancée étendent la technologie de photopléthysmographie au-delà de la mesure de la concentration en oxygène et de la fréquence cardiaque. La quantification de la variation respiratoire du tracé photopléthysmographique reflète la variation respiratoire du tracé de pression artérielle et peut servir à jauger la réactivité au volume. Les deux techniques de compression volumique (volume-clamp) au doigt et la technique physiocal sont des prolongements de Author contributions Karsten Bartels wrote approximately 50% of the manuscript and critically edited the remainder. Robert H. Thiele wrote approximately 50% of the manuscript and critically edited the remainder.

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“…Several studies have confirmed that PVI can predict the cardiovascular response to both passive leg raising 81 and fluid administration in patients whose lungs are mechanically ventilated. [82][83][84][85] Despite the growing body of data suggesting that PVI is capable of predicting fluid responsiveness, there does not seem to be strong agreement between PVI and PPV. [86][87][88][89][90] The reasons for this paradox (excellent predictor of fluid responsiveness yet not in agreement with arterial-derived metrics) are not clear but may be related to the dependence of PVI on perfusion.…”

Section: Technological Assessmentmentioning

confidence: 99%

Inter-device differences in monitoring for goal-directed fluid therapy

Thiele

Bartels

Gan

2014

Can J Anesth/J Can Anesth

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Pleth variability index predicts fluid responsiveness in critically ill patients*

Abstract: The pleth variability index can predict fluid responsiveness noninvasively in intensive care unit patients under mechanical ventilation.

Cited by 95 publications

References 44 publications

Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters

Perfusion index and plethysmographic variability index in patients with interscalene nerve catheters

Advances in photoplethysmography: beyond arterial oxygen saturation

Inter-device differences in monitoring for goal-directed fluid therapy

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