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J Crit Care. 2013 Oct;28(5):634-9. doi: 10.1016/j.jcrc.2013.03.011. Epub 2013 May 15.

Plethysmographic variation index predicts fluid responsiveness in ventilated patients in the early phase of septic shock in the emergency department: a pilot study.

Author information

1
Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Hôpital de Belfort, Belfort, France.

Abstract

PURPOSE:

Feasibility study examining whether plethysmographic variability index (PVI) can predict fluid responsiveness in mechanically ventilated patients in the early phase of septic shock in the emergency department.

MATERIALS AND METHODS:

Monocentric, prospective, observational study that included 31 mechanically ventilated and sedated patients with septic shock in whom volume expansion was planned. The patients were equipped with a pulse oximeter that automatically calculated and displayed PVI. The intervention consisted in infusing 8 mL/kg of hydroxylethyl starch over a 20-minute period. Before and after intervention, we recorded PVI and measured the aortic velocity-time integral (VTIao) using transthoracic echocardiography. Responders were defined as patients who increased their VTIao by 15% or higher after fluid infusion.

RESULTS:

Sixteen patients were classified as responders, and 15 as nonresponders. Mean PVI values before intervention were significantly higher in responders vs nonresponders (30%±9% vs 8%±5%, P<.001). Plethysmographic variability index values before intervention were correlated with percent changes in VTIao induced by intervention (R2=0.67; P<.001). A PVI threshold value of 19% discriminates responders from nonresponders with a sensitivity of 94% and a specificity of 87% (area under the curve, 0.97; P<.001).

CONCLUSION:

Our study suggests that PVI is a feasible and interesting method to predict fluid responsiveness in early phase septic shock patients in the emergency department.

KEYWORDS:

Fluid resuscitation; Heart-lung interactions; Mechanical ventilation; Plethysmographic variation index; Septic shock; Volume responsiveness

PMID:
23683565
DOI:
10.1016/j.jcrc.2013.03.011
[Indexed for MEDLINE]

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