Prediction of fluid responsiveness in mechanically ventilated patients in surgical intensive care unit by pleth variabil
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(2020) 12:48
Ain-Shams Journal of Anesthesiology
ORIGINAL ARTICLE
Open Access
Prediction of fluid responsiveness in mechanically ventilated patients in surgical intensive care unit by pleth variability index and inferior vena cava diameter Diaaeldin Badr Metwally Kotb Aboelnile* , Mohamed Ismail Abdelfattah Elseidy, Yasir Ahmed Elbasiony Mohamed Kenawey and Ibrahim Mohammed Alsayed Ahmed Elsherif
Abstract Background: Patients may have signs of hypovolemia, but fluid administration is not always beneficial. We are in need of bedside devices and techniques, which can predict fluid responsiveness effectively and safely. This study is aiming to compare the effectiveness and reliability of the pleth variability index (PVI) and IVC distensibility index (dIVC) as predictors of fluid responsiveness by simultaneous recordings in all sedated mechanically ventilated patients in the surgical intensive care unit (ICU). We used the passive leg raising test (PLR) as a harmless reversible technique for fluid challenge, and patients were considered responders if the cardiac index (CI) measured by transthoracic echocardiography (TTE) increased ≥ 15% after passive leg raising test (PLR). Results: This observational cross-sectional study was performed randomly on 88 intubated ventilated sedated patients. Compared with CI measured by transthoracic echocardiography, the dIVC provided 79.17% sensitivity and 80% specificity at a threshold value of > 19.42% for fluid responsiveness prediction and was statistically significant (P < .0001), with an area under the curve (AUC) of 0.886 (0.801–0.944), while PVI at a threshold value of > 14% provided 93.75% sensitivity and 87.5% specificity and was statistically significant (P < .0001), with an AUC of 0.969 (0.889–0.988). Conclusion: PVI and dIVC are effective non-invasive bedside methods for the assessment of fluid responsiveness in ICU for intubated ventilated sedated patients with sinus rhythm, but PVI has the advantage of being continuous, operator-independent, and more reliable than dIVC. Keywords: Fluid responsiveness, Hemodynamic monitoring, Inferior vena cava diameter, Pleth variability index, Ultrasound
Background Perioperative prediction of fluid responsiveness has been a challenge for many years. It is known as the ability of the circulation to increase cardiac output (CO) in response to volume expansion. Accommodation of the large volume of venous return (VR) is done by stretching * Correspondence: [email protected] Department of Anesthesiology, Intensive care and Pain Management, Faculty of Medicine, Ain-Shams University, Abbassia, Cairo 11591, Egypt
ventricles, which is known as cardiac preload. Since preload is related to CO, increased negativity of intrathoracic pressure (ITP) during inspiration subsequently increases VR and subsequently CO, and the reverse occurs during expiration (Chu et al., 2016). Hemodynamic optimization by intravenous (IV) fluid administration is very important to correct any fluid deficits created by fasting, blood loss, and urinary excretion, or i
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