Plethysmographic Variability Index (<scp>PVI</scp>) accuracy in predicting fluid responsiveness in anesthetized children

Julien, Florence; Hilly, Julie; Sallah, Tarik B.; Skhiri, Alia; Michelet, D.; Brasher, Christopher; Varin, Laurent; Nivoche, Y.; Dahmani, Souhayl

doi:10.1111/pan.12139

Cited by 36 publications

(27 citation statements)

References 43 publications

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“…Data recorded in the adult population suggest that PVI predicts fluid responsiveness [14]. Similarly, encouraging data has emerged in the pediatric population as well [15][16][17]. In the present study, there were no significant changes in the PVI following phlebotomy when the cohort was analyzed as a whole.…”

Section: Discussionsupporting

confidence: 61%

“…Another measure of plethysmography variation has been developed and incorporated into a new generation of pulse oximetry (Radical 7 pulse oximeter, Masimo Corporation, Irvine CA) and deemed the pleth variability index (PVI). A recent meta-analysis in adults [14], and three recent pediatric studies have shown PVI to accurately predict fluid responsiveness [15][16][17].…”

Section: B Schloss Et Al / Plethysmography Variability Index Duringmentioning

confidence: 99%

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Plethysmography variability index response to isovolemic hemodilution in children prior to surgery for congenital heart disease

Schloss

Naguib

Bissonnette

et al. 2015

J Pediatr Intensive Care

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The aim of this study was to evaluate the response of pleth variability index (PVI) to phlebotomy in anesthetized children prior to surgery for congenital heart disease. After induction of general anesthesia and prior to surgical incision, approximately 10 mL/kg of blood was removed from 40 mechanically ventilated children over a 5?10 min period. The PVI was continuously monitored. Additionally, the volume of crystalloid required to ensure hemodynamic and near infrared spectroscopy stability was recorded. There was no difference between the pre-phlebotomy PVI (13% ? 6.2) and the post-phlebotomy PVI (16.4% ? 9.6) (P = 0.55). Patients who had a starting PVI ?14% had a significant increase in PVI after phlebotomy from 9.1% ? 3 to 14.3% ? 7.2 (P = 0.0014). Although, patients with a pre-phlebotomy PVI of >14% required more crystalloid replacement (11 ? 9.4 mL/kg) than those with a PVI ?14% (5.3 ? 4.7 mL/kg), this was not significant (P = 0.06). In patients who received less crystalloid replacement during phlebotomy, PVI did show a significant increase. Additionally, the data suggests that patients with a pre-phlebotomy PVI >14% required greater fluid replacement than those with a PVI < 14%. Further research is needed to better delineate the utility of PVI in this unique group of patients.

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Section: Discussionsupporting

confidence: 61%

Section: B Schloss Et Al / Plethysmography Variability Index Duringmentioning

confidence: 99%

Plethysmography variability index response to isovolemic hemodilution in children prior to surgery for congenital heart disease

Schloss

Naguib

Bissonnette

et al. 2015

J Pediatr Intensive Care

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“…By contrast, the Doppler peak velocity of descending aortal blood flow was noted as being less predictive of fluid responsiveness in critically ill children . In addition, a systematic analysis of 12 studies found that both PPV and SVV failed to predict fluid responsiveness, and the prediction value of PVI was inconclusive . These findings indicate that respiratory cyclic changes in hemodynamics are less reliably detectable in the peripheral circulation of the pediatric population because children have more compliant arteries and a more compliant thorax .…”

Section: Discussionmentioning

confidence: 94%

Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis: A prospective study

Chen

Chan

Liao

et al. 2020

Pediatric Anesthesia

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Background We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified. Aims To investigate the accuracy of dynamic preload variables for predicting fluid responsiveness in pediatric patients with cirrhosis. Methods A total of 27 pediatric patients with cirrhosis undergoing orthotopic liver transplantation were enrolled in this study. Patients’ pulse pressure variation, stroke volume variation, stroke volume index, and central venous pressure were measured using the calibrated pulse contour cardiac output system. The plethysmographic variability index was measured using a Masimo Radical 7 co‐oximeter. During the hepatic dissection phase of the surgery, repeated intraoperative fluid challenges with 10 mL kg−1 of crystalloid within 15 minutes were administered. Fluid responsiveness was defined as an increase in stroke volume index of ≥15% after fluid challenge. Results A total of 61 fluid challenges were administered resulting in 15 fluid responders and 46 fluid nonresponders. Fluid challenge induced significant decreases in all three dynamic preload variables but not in the fluid nonresponders. However, the area under the receiver operating characteristic curves for pulse pressure variation, stroke volume variation, plethysmographic variability index, and central venous pressure for predicting fluid responsiveness were 0.67 (95% confidence interval: 0.52‐0.82; P = .0255), 0.68 (95% confidence interval: 0.54‐0.83; P = .0140), 0.56 (95% confidence interval: 0.40‐0.71; P = .4724), and 0.57 (95% confidence interval: 0.40‐0.74; P = .4192), respectively. Conclusions Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.

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“…In all original publications included in this systematic review, the authors proposed a single cutoff point for DVPeak to make a clinical discrimination between responders and nonresponders to fluid challenge. Nevertheless, recent studies suggest that this threshold value, determined using a classic ROC curve approach, does not allow certainty in the determination of fluid-responsive status due to the existence of an inconclusive 'gray zone' that has been identified for several dynamic parameters of fluid responsiveness in adults and children (41)(42)(43)(44). We believe that it would be of great interest to specifically define the gray zone of DVPeak for mechanically ventilated children in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta‐analysis

Desgranges

Desebbe

Neto

et al. 2015

Pediatric Anesthesia

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Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.

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Plethysmographic Variability Index (PVI) accuracy in predicting fluid responsiveness in anesthetized children

Abstract: This study found both PVI and prechallenge SVI to be accurate when used to predict fluid load response during anesthetized noncardiac surgery in children. However, a third of recorded PVI values were inconclusive.

Cited by 36 publications

References 43 publications

Plethysmography variability index response to isovolemic hemodilution in children prior to surgery for congenital heart disease

Plethysmography variability index response to isovolemic hemodilution in children prior to surgery for congenital heart disease

Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis: A prospective study

Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta‐analysis

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