Use of plethysmographic variability index derived from the Massimo®pulse oximeter to predict fluid or preload responsiveness: a systematic review and meta-analysis

Abstract Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and update of the meta-analysis needs to be completed. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The area under the curve (AUC) of receiver operating characteristics (ROC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of the without undergoing surgery subgroup (AUC =0.86, Youden index =0.65) and ICU subgroup (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can play an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Patients who are expanded with colloid and patients who undergoing cardiac surgery may be more suitable for PVI.

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Pleth variability index may predict preload responsiveness in patients treated with nasal high flow: a physiological study

Journal of Applied Physiology ◽

10.1152/japplphysiol.00614.2020 ◽

2021 ◽

Author(s):

Marina García de Acilu ◽

Andrés Pacheco ◽

Manel Santafé ◽

Francisco-Javier Ramos ◽

Juan C. Ruiz-Rodríguez ◽

...

Keyword(s):

Stroke Volume ◽

Diagnostic Accuracy ◽

Fluid Challenge ◽

High Flow ◽

Passive Leg Raising ◽

Strongly Correlated ◽

Pleth Variability Index ◽

Preload Responsiveness ◽

Variability Index ◽

Plethysmographic Variability Index

The purpose of this study was to determine whether the plethysmographic variability index (PVi) can predict preload responsiveness in nasal high flow (NHF) patients (≥30 L/min) with any sign of hypoperfusion. Preload responsiveness was defined as a ≥10% increase in stroke volume (SV), measured by transthoracic echocardiography, after passive leg raising. SV and PVi were reassessed in preload responders after receiving a 250-mL fluid challenge. Twenty patients were included, and 12 patients (60%) were preload responders. Responders showed higher baseline mean PVi (24% vs. 13%; p=0.001) and higher mean PVi variation (∆PVi) after passive leg raising (6.8% vs. -1.7%; p<0.001). No differences between mean ∆PVi after passive leg raising and mean ∆PVi after fluid challenge were observed (6.8 % vs. 7.4%; p=0.24), and both values were strongly correlated (r=0.84; p<0.001). Baseline PVi and ∆PVi after passive leg raising showed excellent diagnostic accuracy identifying preload responders (AUROC 0.92 and 1.00, respectively). Baseline PVi ≥16% had a sensitivity of 91.7% and a specificity of 87.5% for detecting preload responders. Similarly, ∆PVi after passive leg raising ≥2%, had a 100% of both sensitivity and specificity. Thus, PVi might predict preload responsiveness in patients treated with NHF, suggesting that it may guide fluid administration in these patients.

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Reliability of pleth variability index in predicting preload responsiveness of mechanically ventilated patients under various conditions: a systematic review and meta-analysis

10.21203/rs.2.300/v3 ◽

2019 ◽

Author(s):

Tianyu Liu ◽

Chao Xu ◽

Min Wang ◽

Zheng Niu ◽

Dun yi Qi

Keyword(s):

Meta Analysis ◽

Cochrane Library ◽

Youden Index ◽

Pleth Variability Index ◽

Operating Characteristics ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Preload Responsiveness ◽

Variability Index ◽

Ventilated Patients

Abstract Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and update of the meta-analysis needs to be completed. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The area under the curve (AUC) of receiver operating characteristics (ROC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of subgroup of patients without undergoing surgery (AUC =0.86, Youden index =0.65) and the results of subgroup of patients in ICU (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can play an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Patients who are expanded with colloid may be more suitable for PVI.

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Reliability of pleth variability index in predicting preload responsiveness of mechanically ventilated patients under various conditions: a systematic review and meta-analysis

10.21203/rs.2.300/v1 ◽

2019 ◽

Author(s):

Tianyu Liu ◽

Chao Xu ◽

Min Wang ◽

Zheng Niu ◽

Dun yi Qi

Keyword(s):

Meta Analysis ◽

Fluid Management ◽

Cochrane Library ◽

Youden Index ◽

Pleth Variability Index ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Preload Responsiveness ◽

Variability Index ◽

Ventilated Patients

Abstract Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and new meta-analysis needs to be updated. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The pooled area under the receiver operating characteristic (AUC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of the without undergoing surgery subgroup (AUC =0.86, Youden index =0.65) and ICU subgroup (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can plays an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Keywords: Pleth variability index, Preload responsiveness, Mechanically ventilated patients, Meta-analysis.

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Reliability of pleth variability index in predicting preload responsiveness of mechanically ventilated patients under various conditions: a systematic review and meta-analysis

10.21203/rs.2.300/v5 ◽

2019 ◽

Author(s):

Tianyu Liu ◽

Chao Xu ◽

Min Wang ◽

Zheng Niu ◽

Dunyi Qi

Keyword(s):

Meta Analysis ◽

Cochrane Library ◽

Youden Index ◽

Pleth Variability Index ◽

Operating Characteristics ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Preload Responsiveness ◽

Variability Index ◽

Ventilated Patients

Abstract Abstract Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and update of the meta-analysis needs to be completed. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The area under the curve (AUC) of receiver operating characteristics (ROC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of subgroup of patients without undergoing surgery (AUC =0.86, Youden index =0.65) and the results of subgroup of patients in ICU (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can play an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Patients who are expanded with colloid may be more suitable for PVI.

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