Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults: a systematic review and meta-analysis
- 26 June 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 38 (9), 1429-1437
- https://doi.org/10.1007/s00134-012-2621-1
Abstract
To systematically review the accuracy of the variation in pulse oxymetry plethysmographic waveform amplitude (∆POP) and the Pleth Variability Index (PVI) as predictors of fluid responsiveness in mechanically ventilated adults. MEDLINE, Scopus and the Cochrane Database of Systematic Reviews were screened for clinical studies in which the accuracy of ∆POP/PVI in predicting the hemodynamic response to a subsequent fluid bolus had been investigated. Random-effects meta-analysis was used to summarize the results. Data were stratified according to the amount of fluid bolus (large vs. small) and to the study index (∆POP vs. PVI). Ten studies in 233 patients were included in this meta-analysis. All patients were in normal sinus rhythm. The pooled area under the receiver operating characteristic curve (AUC) for identification of fluid responders was 0.85 [95 % confidence interval (CI) 0.79–0.92]. Pooled sensitivity and specificity were 0.80 (95 % CI 0.74–0.85) and 0.76 (0.68–0.82), respectively. No heterogeneity was found within studies with the same amount of fluid bolus, nor between studies on ∆POP and those on PVI. The AUC was significantly larger in studies with a large bolus amount than in those with a small bolus [0.92 (95 % CI 0.87–0.96) vs. 0.70 (0.62–0.79); p < 0.0001]. Sensitivity and specificity were also higher in studies with a large bolus [0.84 (95 % CI 0.77–0.90) vs. 0.72 (0.60–0.82) (small bolus), p = 0.08 and 0.86 (95 % CI 0.75–0.93) vs. 0.68 (0.56–0.77) (small bolus), p = 0.02], respectively. Based on our meta-analysis, we conclude that ∆POP and PVI are equally effective for predicting fluid responsiveness in ventilated adult patients in sinus rhythm. Prediction is more accurate when a large fluid bolus is administered.Keywords
This publication has 43 references indexed in Scilit:
- Photoplethysmographic and pulse pressure variations during abdominal surgeryActa Anaesthesiologica Scandinavica, 2011
- Impact of norepinephrine on the relationship between pleth variability index and pulse pressure variations in ICU adult patientsCritical Care, 2011
- Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA StatementJournal of Clinical Epidemiology, 2009
- Poor Agreement between Respiratory Variations in Pulse Oximetry Photoplethysmographic Waveform Amplitude and Pulse Pressure in Intensive Care Unit PatientsAnesthesiology, 2008
- Does Central Venous Pressure Predict Fluid Responsiveness?*: A Systematic Review of the Literature and the Tale of Seven MaresChest, 2008
- Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatreBritish Journal of Anaesthesia, 2008
- Evaluation of Finger and Forehead Pulse Oximeters during Mild Hypothermic Cardiopulmonary BypassJournal of Clinical Monitoring and Computing, 2007
- The Use of Joint Time Frequency Analysis to Quantify the Effect of Ventilation on the Pulse Oximeter WaveformJournal of Clinical Monitoring and Computing, 2006
- Pulse oximeter as a sensor of fluid responsiveness: do we have our finger on the best solution?Critical Care, 2005
- Pulse oximetry plethysmographic waveform during changes in blood volumeBritish Journal of Anaesthesia, 1999