Agreement between Pleth Variability Index and oesophageal Doppler to predict fluid responsiveness
- 16 September 2015
- journal article
- research article
- Published by Wiley in Acta Anaesthesiologica Scandinavica
- Vol. 60 (2), 183-192
- https://doi.org/10.1111/aas.12632
Abstract
Optimisation of stroke volume using oesophageal Doppler is an established technique to guide intraoperative fluid therapy. The method has practical limitations and therefore alternative indices of fluid responsiveness, such as ventilator-induced variation in the pulse oximetric signal (Pleth Variability Index (PVI)) could be considered. We hypothesised that both methods predict fluid responsiveness in a similar way. Seventy-five patients scheduled for open major abdominal surgery were randomised to fluid optimisation using fluid bolus algorithms based on either PVI (n = 35) or Doppler (n = 39). All patients were monitored with both methods; the non-guiding method was blind. Primary endpoint was the concordance between the methods to predict fluid responsiveness. We also analysed the ability of each method to predict a stroke volume increase ≥ 10% after a fluid bolus, as well as the accumulated intraoperative bolus fluid volume. PVI indicated a need for fluid in one-third of the situations when Doppler did so, Cohen's kappa = 0.03. A fluid bolus indicated by the PVI algorithm increased stroke volume by ≥ 10% in half the situations. The same was found for the Doppler algorithm. The mean total bolus volume given was 878 ml when the fluid management was governed by PVI compared to 826 ml with Doppler (P = 0.71). PVI- and Doppler-based stroke volume optimisations agreed poorly, which did not affect the amount of fluid administered. None of the algorithms showed a good ability to predict fluid responsiveness. Our results do not support the fluid responsiveness concept.Keywords
Funding Information
- Department of Anaesthesiology and Intensive Care
- Linköping University Hospital
- County Council of Östergötland
This publication has 21 references indexed in Scilit:
- Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults: a systematic review and meta-analysisIntensive Care Medicine, 2012
- Pleth Variability Index to Predict Fluid Responsiveness in Colorectal SurgeryAnesthesia & Analgesia, 2011
- Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgeryBritish Journal of Anaesthesia, 2011
- Assessing the Diagnostic Accuracy of Pulse Pressure Variations for the Prediction of Fluid ResponsivenessAnesthesiology, 2011
- Impact of skin incision on the pleth variability indexJournal of Clinical Monitoring and Computing, 2011
- Goal-Directed Fluid Management Based on the Pulse Oximeter–Derived Pleth Variability Index Reduces Lactate Levels and Improves Fluid ManagementAnesthesia & Analgesia, 2010
- Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgeryEuropean Journal of Anaesthesiology, 2010
- The Ability of Pleth Variability Index to Predict the Hemodynamic Effects of Positive End-Expiratory Pressure in Mechanically Ventilated Patients Under General AnesthesiaAnesthesia & Analgesia, 2010
- Stroke volume averaging for individualized goal‐directed fluid therapy with oesophageal DopplerActa Anaesthesiologica Scandinavica, 2008