Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery

Brandon Maughan, Todd A. Seigel, Anthony M. Napoli

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. Objectives To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. Methods A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15% during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. Results In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42% of intubated patients and 48% of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P= .16) or spontaneously breathing patients (area under curve, 0.41; P= .75). Conclusions Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.

Original languageEnglish (US)
Pages (from-to)172-175
Number of pages4
JournalAmerican Journal of Critical Care
Volume24
Issue number2
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Pulmonary Artery
Thermodilution
Respiration
Oximetry
Catheters
Thoracic Surgery
Area Under Curve
Leg
Vital Signs
Artificial Respiration
Cardiac Output
Observational Studies
Prospective Studies

ASJC Scopus subject areas

  • Critical Care

Cite this

Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery. / Maughan, Brandon; Seigel, Todd A.; Napoli, Anthony M.

In: American Journal of Critical Care, Vol. 24, No. 2, 01.01.2015, p. 172-175.

Research output: Contribution to journalArticle

@article{c5222cf9d82243c6a4c2d51c4b52c479,
title = "Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery",
abstract = "Background Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. Objectives To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. Methods A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15{\%} during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. Results In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42{\%} of intubated patients and 48{\%} of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P= .16) or spontaneously breathing patients (area under curve, 0.41; P= .75). Conclusions Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.",
author = "Brandon Maughan and Seigel, {Todd A.} and Napoli, {Anthony M.}",
year = "2015",
month = "1",
day = "1",
doi = "10.4037/ajcc2015864",
language = "English (US)",
volume = "24",
pages = "172--175",
journal = "American Journal of Critical Care",
issn = "1062-3264",
publisher = "American Association of Critical Care Nurses",
number = "2",

}

TY - JOUR

T1 - Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery

AU - Maughan, Brandon

AU - Seigel, Todd A.

AU - Napoli, Anthony M.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. Objectives To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. Methods A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15% during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. Results In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42% of intubated patients and 48% of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P= .16) or spontaneously breathing patients (area under curve, 0.41; P= .75). Conclusions Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.

AB - Background Fluid responsiveness is a measure of preload dependence and is defined as an increase in cardiac output due to volume expansion. Recent publications have suggested that variation in amplitude of the pulse oximetry waveform may be predictive of fluid responsiveness. The pleth variability index (PVI) was developed as a noninvasive bedside measurement of this variation in the pulse oximetry waveform. Objectives To measure the discriminatory value of PVI for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution in patients after cardiothoracic surgery. Methods A prospective observational study of hemodynamically stable postoperative cardiac surgery patients with pulmonary artery catheters. A fingertip sensor was used to measure PVI. Vital signs, PVI, and cardiac index were measured before, during, and after passive leg raise. Fluid responsiveness was defined by increase in cardiac index of greater than 15% during passive leg raise. The discriminatory value of PVI was assessed by using the Wilcoxon method to measure the area under the receiver operating curve. Results In 13 months, 47 patients (24 receiving mechanical ventilation, 23 spontaneously breathing) were enrolled. Fluid responsiveness was noted in 42% of intubated patients and 48% of spontaneously breathing patients. PVI was not adequate to discriminate fluid responsiveness in intubated patients (area under curve, 0.63; P= .16) or spontaneously breathing patients (area under curve, 0.41; P= .75). Conclusions Among postoperative cardiac surgery patients, PVI is not reliable for predicting fluid responsiveness as measured by pulmonary artery catheter thermodilution, regardless of ventilatory status.

UR - http://www.scopus.com/inward/record.url?scp=84924913735&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924913735&partnerID=8YFLogxK

U2 - 10.4037/ajcc2015864

DO - 10.4037/ajcc2015864

M3 - Article

C2 - 25727278

AN - SCOPUS:84924913735

VL - 24

SP - 172

EP - 175

JO - American Journal of Critical Care

JF - American Journal of Critical Care

SN - 1062-3264

IS - 2

ER -