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.

scholarly journals The Validity of Central Venous to Arterial Carbon Dioxide Difference to Predict Adequate Fluid Management during Living Donor Liver Transplantation: A Prospective Observational Study.

2019 ◽  
Author(s):  
Hisham Hosny ◽  
Mohamed Elayashy ◽  
Amr Hussein ◽  
Ahmed Abdelaal Ahmed Mahmoud ◽  
Ahmed Mukhtar ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Fluid Responsiveness ◽  
Fluid Management ◽  
Central Venous ◽  
Predict Fluid Responsiveness ◽  
Discriminative Ability ◽  
Donor Liver Transplantation ◽  
Pulmonary Artery Catheters ◽  
Data Points ◽  
End Stage

Abstract Background: Patients with End-stage liver disease undergoing orthotopic liver transplantation are prone to serious hemodynamic and metabolic derangements. The study aimed to assess the validity of central and pulmonary veno-arterial CO2 gradients to predict fluid responsiveness and to guide fluid management during liver transplantation. Methods: In adult recipients of liver transplantation, ASA III to IV, pulse pressure variations (PPV) guided intraoperative fluid management. PPV of ≥15% (Fluid Responding Status-FRS) indicated fluid resuscitation with 250 ml albumin 5% boluses repeated if required to correct PPV to <15% (Fluid non-Responding Status-FnRS). Samples from central venous and pulmonary artery catheters (PAC) were collected simultaneously to calculate both the central venous to arterial CO2 gap [C(v-a) CO2 gap] and the pulmonary venous to arterial CO2 gap [Pulm(p-a) CO2 gap]. Results: Primary outcome was the sensitivity of central venous CO2 gap to differentiate between fluid responding and non-responding states with 67 data points recorded (20 FRS and 47 FnRS). The discriminative ability of central and pulmonary CO2 gaps between the two statuses (FRS and FnRS) was poor with AUC of ROC of 0.698 and 0.570 respectively. The central CO2 gap was significantly higher in FRS than FnRS (P=0.016), with no difference in pulmonary CO2 gap between both statuses. The central and pulmonary CO2 gaps were weakly correlated to PPV [r=0.291, (P=0.017) and r=0.367, (P=0.002) respectively]. No correlation between both CO2 gaps and both CO and lactate could be seen. Conclusion: The Central and the Pulmonary CO2 gaps cannot be used as valid tools to predict fluid responsiveness and to guide fluid management during liver transplantation. CO2 gaps also do not correlate well with the changes in PPV or CO.

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 Evaluation of pleth variability index as a predictor of fluid responsiveness during orthotopic liver transplantation

2016 ◽  
Vol 32 (7) ◽  
pp. 373-380 ◽  
Author(s):  
Huseyin Konur ◽  
Gulay Erdogan Kayhan ◽  
Huseyin Ilksen Toprak ◽  
Nizamettin Bucak ◽  
Mustafa Said Aydogan ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Fluid Responsiveness ◽  
Orthotopic Liver Transplantation ◽  
Pleth Variability Index ◽  
Variability Index

Non-invasive prediction of fluid responsiveness in infants using pleth variability index

Anaesthesia ◽  
2011 ◽  
Vol 66 (7) ◽  
pp. 582-589 ◽  
Author(s):  
J. Renner ◽  
O. Broch ◽  
M. Gruenewald ◽  
J. Scheewe ◽  
H. Francksen ◽  
...  
Keyword(s):  
Fluid Responsiveness ◽  
Pleth Variability Index ◽  
Non Invasive ◽  
Variability Index

scholarly journals Non-invasive assessment of fluid responsiveness to guide fluid therapy in patients with sepsis in the emergency department: a prospective cohort study

2021 ◽  
pp. emermed-2020-209771
Author(s):  
Nienke K Koopmans ◽  
Renate Stolmeijer ◽  
Ben C Sijtsma ◽  
Paul A van Beest ◽  
Christiaan E Boerma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Fluid Responsiveness ◽  
Prospective Cohort Study ◽  
Fluid Therapy ◽  
Prospective Cohort ◽  
Fluid Challenge ◽  
Fluid Bolus ◽  
Non Invasive ◽  
Similar Patient ◽  
Passive Leg Raise

BackgroundLittle is known about optimal fluid therapy for patients with sepsis without shock who present to the ED. In this study, we aimed to quantify the effect of a fluid challenge on non-invasively measured Cardiac Index (CI) in patients presenting with sepsis without shock.MethodsIn a prospective cohort study, CI, stroke volume (SV) and systemic vascular resistance (SVR) were measured non-invasively in 30 patients presenting with sepsis without shock to the ED of a large teaching hospital in the Netherlands between May 2018 and March 2019 using the ClearSight system. After baseline measurements were performed, a passive leg raise (PLR) was done to simulate a fluid bolus. Measurements were then repeated 30, 60, 90 and 120 s after PLR. Finally, a standardised 500 mL NaCl 0.9% intravenous bolus was administered after which final measurements were done. Fluid responsiveness was defined as >15% increase in CI after a standardised fluid challenge.Measurements and main resultsSeven out of 30 (23%) patients demonstrated a >15% increase in CI after PLR and after a 500 mL fluid bolus. Fluid responders had a higher estimated glomerular filtration rate (eGFR) (64 (44–78) vs 37 (23–47), p=0.009) but otherwise similar patient and treatment characteristics as non-responders. Baseline measurements of cardiac output (CO), CI, SV and SVR were unrelated to PLR fluid responsiveness. The change in CI after PLR was strongly positive correlated to the change in CI after a 500 mL NaCl 0.9% fluid bolus (r=0.88, p<0.001).ConclusionThe results of the present study demonstrate that in patients with sepsis in the absence of shock, three out of four patients do not demonstrate a clinically relevant increase in CI after a standardised fluid challenge. Non-invasive CO monitoring in combination with a PLR test has the potential to identify patients who might benefit from fluid resuscitation and may contribute to a better tailored treatment of these patients.

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