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BJA Advance Access published online on June 2, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen133
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre

M. Cannesson1,*,{dagger}, O. Desebbe1, P. Rosamel1, B. Delannoy1, J. Robin2, O. Bastien1 and J.-J. Lehot1

1 Department of Anaesthesiology and Intensive Care
2 Department of Cardiac Surgery, Hospices Civils de Lyon, Louis Pradel Hospital, Claude Bernard Lyon 1 University, ERI 22 Lyon, France

* Corresponding author: Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 Avenue du Doyen Lépine, 69500 Bron, France. E-mail: maxime_cannesson{at}hotmail.com

Background: Respiratory variations in pulse oximetry plethysmographic waveform amplitude ({Delta}POP) can predict fluid responsiveness in mechanically ventilated patients but cannot be easily assessed at the bedside. Pleth variability index (PVI) is a new algorithm allowing for automated and continuous monitoring of {Delta}POP. We hypothesized that PVI can predict fluid responsiveness in mechanically ventilated patients under general anaesthesia.

Methods: Twenty-five patients were studied after induction of general anaesthesia. Haemodynamic data [cardiac index (CI), respiratory variations in arterial pulse pressure ({Delta}PP), {Delta}POP, and PVI] were recorded before and after volume expansion (500 ml of hetastarch 6%). Fluid responsiveness was defined as an increase in CI ≥15%.

Results: Volume expansion induced changes in CI [2.0 (SD 0.9) to 2.5 (1.2) litre min–1 m–2; P<0.01], {Delta}POP [15 (7)% to 8 (3)%; P<0.01], and PVI [14 (7)% to 9 (3)%; P<0.01]. {Delta}POP and PVI were higher in responders than in non-responders [19 (9)% vs 9 (4)% and 18 (6)% vs 8 (4)%, respectively; P<0.01 for both]. A PVI >14% before volume expansion discriminated between responders and non-responders with 81% sensitivity and 100% specificity. There was a significant relationship between PVI before volume expansion and change in CI after volume expansion (r=0.67; P<0.01).

Conclusions: PVI, an automatic and continuous monitor of {Delta}POP, can predict fluid responsiveness non-invasively in mechanically ventilated patients during general anaesthesia. This index has potential clinical applications.

Keywords: equipment, pulse oximeter; fluids, i.v.; heart, cardiac output; monitoring, cardiopulmonary; monitoring, intraoperative

{dagger} Declaration of interest. M.C. is a member of Masimo Corp. scientific advisory board.


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