scholarly journals Pleth variability index and fluid management practices: a multicenter service evaluation

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Patrice Forget ◽  
Simon Lacroix ◽  
Eric P. Deflandre ◽  
Anne Pirson ◽  
Nicolas Hustinx ◽  
...  
Keyword(s):  
Management Practices ◽  
New Technology ◽  
Fluid Management ◽  
Service Evaluation ◽  
Pleth Variability Index ◽  
Clinical Practices ◽  
Non Invasive ◽  
Before And After ◽  
Variability Index

Abstract Objectives The introduction of a new technology has the potential to modify clinical practices, especially if easy to use, reliable and non-invasive. This observational before/after multicenter service evaluation compares fluid management practices during surgery (with fluids volumes as primary outcome), and clinical outcomes (secondary outcomes) before and after the introduction of the Pleth Variability Index (PVI), a non-invasive fluid responsiveness monitoring. Results In five centers, 23 anesthesiologists participated during a 2-years period. Eighty-eight procedures were included. Median fluid volumes infused during surgery were similar before and after PVI introduction (respectively, 1000 ml [interquartile range 25–75 [750–1700] and 1000 ml [750–2000]). The follow-up was complete for 60 from these and outcomes were similar. No detectable change in the fluid management was observed after the introduction of a new technology in low to moderate risk surgery. These results suggest that the introduction of a new technology should be associated with an implementation strategy if it is intended to be associated with changes in clinical practice.

scholarly journals The accuracy of Pleth Variability Index for directed fluid optimization in donors in living donor liver transplantation

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Amr M. Hilal Abdou ◽  
Khaled M. Abdou ◽  
Mohammed M. Kamal
Keyword(s):  
Liver Transplantation ◽  
Fluid Responsiveness ◽  
Fluid Management ◽  
Bolus Administration ◽  
Pleth Variability Index ◽  
Fluid Bolus ◽  
Donor Liver Transplantation ◽  
Non Invasive ◽  
Right Lobe ◽  
Variability Index

Abstract Background Fluid management strongly affects hepatic resection and aims to reduce intraoperative bleeding during living donation. The Pleth Variability Index (PVI) is a tool to assess the fluid responsiveness from the pulse oximeter waveform; we evaluated the efficacy and accuracy of finger PVI compared to pulse pressure variation (PPV) from arterial waveform in predicting the fluid response in donor hepatectomy patients with the guide of non-invasive cardiac output (CO) measurements. We recruited forty patients who were candidates for right lobe hepatectomy for liver transplantation under conventional general anesthesia methods. During periods of intraoperative hypovolemia not affected by surgical manipulation, PVI, PPV, and CO were recorded then compared with definitive values after fluid bolus administration of 3–5 ml/kg aiming to give a 10% increase in CO which classified the patients into responders and non-responders. Results Both PPV and PVI showed a significant drop after fluid bolus dose (P < 0.001) leading to an increase of the CO (P < 0.0001), and the area under the curve was 0.934, 0.842 (95% confidence interval, 0.809 to 0.988, 0.692 to 0.938) and the standard error was 0.0336, 0.124, respectively. Pairwise comparison of PPV and PVI showed non-significant predictive value between the two variables (P = 0.4605); the difference between the two areas was 0.0921 (SE 0125 and 95% CI − 0.152 to 0.337). Conclusions PVI is an unreliable indicator for fluid response in low-risk donors undergoing right lobe hepatectomy compared to PPV. We need further studies with unbiased PVI monitors in order to implement a non-invasive and safe method for fluid responsiveness.

PLETH VARIABILITY INDEX-GUIDED FLUID THERAPY LOWERS POST-OPERATIVE LACTATE LEVELS IN DOGS UNDERGOING ELECTIVE ABDOMINAL SURGERY: A RANDOMIZED CONTROLLED TRIAL

2018 ◽  
Vol 44 (01) ◽  
pp. 7-14
Author(s):  
Chun-Hsiang Hu ◽  
Tien-Huan Hsu ◽  
Kuan-Sheng Chen ◽  
Wei-Ming Lee ◽  
Hsien-Chi Wang
Keyword(s):  
Abdominal Surgery ◽  
Fluid Therapy ◽  
Controlled Trial ◽  
Fluid Management ◽  
Tissue Perfusion ◽  
Control Group ◽  
Pleth Variability Index ◽  
Elective Abdominal Surgery ◽  
Variability Index ◽  
Lactate Levels

To evaluate the hemodynamic optimization effect of pleth variability index (PVI)-guided fluid therapy during abdominal surgery on tissue perfusion, 19 client-owned dogs that underwent elective abdominal surgery were randomized into control ([Formula: see text]) and PVI ([Formula: see text]) groups. In the control group, perioperative fluid management was based on the 2013 AAHA/AAFP Fluid Therapy Guidelines for Dogs and Cats. In the PVI group, the fluid rate was maintained based on basic daily requirements. If PVI was higher than 15% for [Formula: see text][Formula: see text]min, 3–5[Formula: see text]mL/kg of crystalloid fluid bolus was infused. The tissue perfusion indicator, lactate levels, was measured at the time of intubation, extubation, and 6, 12 and 24[Formula: see text]h postoperatively. There were no significant differences in total and average fluid infused between control and PVI groups. The control group had significantly higher lactate levels than that of the PVI group at 12[Formula: see text]h postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]) and overall postoperatively ([Formula: see text][Formula: see text]mmol/L versus [Formula: see text][Formula: see text]mmol/L, [Formula: see text]). The control group revealed more profound hemodilution, as indicated by significantly decreased postoperative blood urea nitrogen (BUN), creatinine, and total protein. PVI-guided fluid therapy lowers lactate levels after elective abdominal surgery in dogs. Therefore, based on the result of this study PVI may provide customized fluid therapy to improve tissue perfusion and avoid unnecessary fluid overload.

Introduction of Hip Ultrasonography to the Neonatal Services of a Fife District General Hospital

1993 ◽  
Vol 6 (2) ◽  
pp. 74-77
Author(s):  
B. Dean ◽  
Donald R. Coid
Keyword(s):  
General Hospital ◽  
Confidence Intervals ◽  
New Technology ◽  
District General Hospital ◽  
X Rays ◽  
Before And After ◽  
Neonatal Hip ◽  
A New Technique ◽  
Hip Ultrasonography

Ultrasonography of the hip is a new technique which is said to assist in the diagnosis of neonatal hip disorders. The authors were unaware of any reports of formal evaluation of the introduction of this new technology into a District General Hospital. This study outlines several aspects of patient care before and after the introduction of neonatal hip ultrasonography to a Fife hospital as an adjunct to a neonatal orthopaedic clinic. After introduction of ultrasound the proportion of patients where the consultant was ‘very confident’ in the diagnosis increased by 29% (95% confidence intervals 9% to 49%); the proportion of children requiring three or more x-rays in the year following referral fell by 46% (95% confidence intervals 27% to 65%) and the proportion of children requiring five or more follow up attendances in the year following referral fell by 56% (95% confidence intervals 38% to 74%). Introduction of this technology has benefited patients by reducing their need to attend clinics and reducing their overall exposure to ionising radiation. There is a continuing need for ultrasonography to be provided in Fife neonatal orthopaedic outpatient clinics.

Long-term effects of empathy training in surgery residents: a one year follow-up study

2013 ◽  
Vol 1 (2) ◽  
pp. 326 ◽  
Author(s):  
Margot Phillips ◽  
Aine Lorie ◽  
John Kelley ◽  
Stacy Gray ◽  
Helen Riess
Keyword(s):  
Long Term Effects ◽  
Clinical Practices ◽  
Empathy Training ◽  
Self Reflection ◽  
Booster Sessions ◽  
Before And After ◽  
Quantitative Analyses ◽  
One Year

Objectives: This study is a 1-year follow-up investigation of the retention of the knowledge, attitudes and skills acquired after empathy training.Methods: Eight otolaryngology residents completed 5 assessment measures before and after empathy training and at 1-year. They attended a 90-minute focus group assessing clinical usefulness of the training, attitudes and factors that affect empathy.Results: Qualitative analysis revealed a positive response to the training and application of skills to clinical practices. Quantitative analyses suggest improvement in empathy after training was maintained at 1-year follow-up (p = 0.05). Knowledge of the neurobiology and physiology of empathy remained significantly greater than before the training (p = 0.007). Conclusions: Qualitative data indicate that the training program was well-received and helpful and follow-up focus groups provided physicians with opportunities for self-reflection and support from peers. Quantitative analysis demonstrated that improvement in self-reported empathy and objective knowledge of the neurobiology of emotions persist at 1-year follow-up. Accordingly, we recommend that empathy training and follow-up booster sessions become a standard component of residency training.

scholarly journals Increasing the Frequency and Timeliness of Pain Assessment and Management in Long-Term Care: Knowledge Transfer and Sustained Implementation

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Thomas Hadjistavropoulos ◽  
Jaime Williams ◽  
Sharon Kaasalainen ◽  
Paulette V. Hunter ◽  
Maryse L. Savoie ◽  
...  
Keyword(s):  
Pain Assessment ◽  
Large Scale ◽  
Management Practices ◽  
Long Term Care ◽  
Future Research ◽  
Clinical Practices ◽  
Term Care ◽  
Staff Members ◽  
Before And After

Background. Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis.Objective. To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so.Methods. The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted.Results. The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain.Discussion. It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices.Conclusions. It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.

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