Weber F, Rashmi BK, Karaoz‐Bulut G, Dogger J, de Heer IJ, Prasser C. The predictive value of the Pleth Variability Index on fluid responsiveness in spontaneously breathing anaesthetized children-A prospective observational study.
Paediatr Anaesth 2020;
30:1124-1131. [PMID:
32767812 PMCID:
PMC7589325 DOI:
10.1111/pan.13991]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND
In children, the preoperative hydration status is an important part of the overall clinical assessment. The assumed preoperative fluid deficit is often routinely replaced during induction without knowing the child's actual fluid status.
AIM
We investigated the predictive value of the Pleth Variability Index as a measure of fluid responsiveness in spontaneously breathing anesthetized children.
METHODS
Pleth Variability Index, stroke volume and Cardiac Index, measured by electrovelocimetry, mean blood pressure, and heart rate were recorded during anesthesia induction in 50 pediatric patients <6 years. Baseline values were compared to values recorded after administration of 10 mL/kg of Ringer's lactate and during two passive leg raising tests (before and after fluid administration). Fluid responsiveness was defined as an increase of ≥10% in stroke volume.
RESULTS
Only in fluid responsive patients, Pleth Variability Index values were higher before fluid administration than thereafter (21.4 ± 5.9% vs 15.0 ± 9.4%, 95% CI of difference 1.1 to 11.8%, P = .02). Pleth Variability Index values at baseline were higher in fluid responders (21.4 ± 5.9%) than in fluid nonresponders (15.3 ± 7.7%), 95% CI of difference 1.6 to 10.6%, P = .009. The area under the receiver operating curve indicating fluid responsiveness was 0.781 (95% CI 0.623 to 0.896, P = .0002), with the highest sensitivity (82%) and specificity (70%) at a Pleth Variability Index of >15% (Positive predictive value 2.71 (95% CI: 1.4 to 5.2)). Only in fluid responders, the Pleth Variability Index decreased during passive leg raising, while stroke volume increased.
CONCLUSIONS
The Pleth Variability Index may be of additional value to predict fluid responsiveness in spontaneously breathing anesthetized children. A significant overlap in baseline Pleth Variability Index values between fluid responsive and nonfluid responsive patients does not allow a reliable recommendation as to a cut off value.
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