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Objective To evaluate the ability of pleth variability index(PVI) for predicting volume responsiveness after general anesthesia induction intubation in the patients undergoing intestinal tract surgery with the velocity-time integral(VTI) of left ventricular outflow tract blood monitored by transthoracic echocardiography as the standard.Methods Twenty-five patients undergoing intestinal tract surgery were selected.After general anesthesia induction,7 mL/kg colloidal solution was infused before operation beginning,if the VTI increased percentage(△VTI％)≥10 ％,200 mL colloidal solution was infused by 50mL syringe until △VTI％＜10％;the hemodynamic indicators of MAP,CVP,HR,PI VTI and PVI were recorded before and after infusion solution.Results The PVI basic value in the patients with response was significantly higher than that in the patients without response(P＜0.05);the Pearson correlation analysis found that there was a significant linear correlation between PVI basic value and △VTI％ before infusion solution(P＜0.05);the optimal diagnostic threshold value of PVI was 13.51,its sensitivity for monitoring the volume responsiveness was 69.25％ and specificity was 70.00％.The area under the receiver operating characteristic(ROC) curve(AUC) was 0.75(95％ CI:0.63-0.88,P＜0.01).Conclusion PVI can predict the volume responsiveness in the patients undergoing intestinal tract surgery.The PVI value ＞13.51 indicates that the patient may be in hypovolemia status and needs the volume therapy.
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Objective Onto investigate the significance of the pleth variability index (PVI) in predicting hypotension after epidural anesthesia for cesarean delivery. Methods Sixity seven pregnant women, with ASAⅠ~Ⅱ, aged 19 ~ 34 years, were enrolled for elective cesarean delivery. SBP, BDP, MAP, HR, PI and PVI were measured at 5 min after the parturients arrived in the operation room. SBP, BDP, MAP and HR were measured every 3 min after epidural anesthesia. According to the change rate of SDP or MAP was higher than 30% or not, the parturients were divided into two groups (the hypotension group and the non-hypotension group). Results No significant differences were found in parturients'age, body height, weight, BMI, gestational weeks, SDP, DBP, MAP and HR before anesthesia between two groups. The PVI in the hypotension group was significantly higher than that in the non-hypotension group (P<0.05). A receiver operator characteristic curve analysis showed the area under curve was 0.888 when PVI was used for boundary value. When PVI over 17.35 was used as the occurrence of hypotension, the sensitivity of PVI was 0.727, and specificity was 0.895. Conclusion PVI can be used to predict the occurrence of hypotension after epidural anesthesia for cesarean delivery.
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Objective To observe the changes of pleth variability index ( PVI) and central venous pressure ( CVP) in patients undergo-ing resection operation of brain neoplasms,and the correlation of PVI with CVP was investigated. Methods Forty-two patients ( ASA Ⅱ~Ⅲ grade) undergoing elective resection operation of brain neoplasms were included in the study. PVI was monitored continously with Masio Radical-7 pulse oximeter after patient entering operative room. CVP was monitored after central venous catheterization placed with regional an-esthesia. Total intravenous anesthesia was chosen. CVP and PVI were recorded at the time of entering operative room,operation began,and 30 minutes,60 minutes,90 minutes,120 minutes after the beginning of operation. Results The correlation coefficient of PVI with CVP was 0. 201 under spontaneously breathing ( at patient entering operative room before anesthesia) and was 0. 237 under mechanical ventilation. Conclusion Correlation of PVI and CVP is lower. The value of PVI might need further research for guiding volume management.
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Objective To evaluate the role ofpleth variability index (PVI) by passive leg raising (PLR) test in volume responsiveness and volume status prediction in patients with septic shock.Methods A prospective randomized controlled trial (RCT) was conducted.Eighty-seven patients suffering from septic shock undergoing mechanical ventilation in Department of Critical Care Medicine of Subei People's Hospital from June 2012 to September 2014 were enrolled.The hemodynamic changes before and after PLR were monitored by pulse indicated continuous cardiac output (PiCCO) and PVI monitoring.Responsive group:positive fluid response was defined as an increase in cardiac index (CI) ≥ 10％ after PLR.Unresponsive group:negative fluid response was defined as an increase in CI ＜ 10％ after PLR.The hemodynamic parameters,including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),stroke volume variation (SVV),CI and PVI,and the changes in cardiac parameters (△ HR,△ MAP,△ CVP,△ SVV,△ CI,and △ PVI) before and after PLR were determined.The relations between hemodynamic parameters and their changes with △ CI were analyzed by the Pearson analysis.The role of the parameters for volume responsiveness prediction was evaluated by receiver operating characteristic (ROC) curves.Results 145 PLRs in 87 patients with septic shock were conducted,with 67 in responsive group and 78 in unresponsive group.There were no statistically significant differences in HR,MAP,CVP and CI before PLR between the responsive and unresponsive groups.SVV and PVI in responsive group were significantly higher than those in the unresponsive group [SVV:(16.9± 3.1)％ vs.(8.4±2.2) ％,t =9.078,P =0.031; PVI:(20.6±4.3)％ vs.(11.1 ±3.2)％,t =19.189,P =0.022].There were no statistically significant differences in HR,MAP,CVP,SVV,and PVI after PLR between the responsive group and unresponsive group.CI in the responsive group was significantly higher than that in the unresponsive group (mL·s-1·m-2:78.3±6.7 vs.60.0±8.3,t =2.902,P =0.025).There were no statistically significant differences in △HR,△MAP,△ CVP between responsive group and unresponsive group.△ SVV,△ CI and △ PVI in responsive group were significantly higher than those in the unresponsive group [△ SVV:(4.6 ± 1.5)％ vs.(1.8 ± 0.9)％,t =11.187,P =0.022;△ CI (mL·s-1·m-2):18.3 ± 1.7 vs.1.7 ± 0.5,t =3.696,P =0.014; △ PVI:(6.4 ± 1.1)％ vs.(1.3 ± 0.2)％,t =19.563,P =0.013].No significant correlation between HR,MAP or CVP before PLR and △ CI was found.SVV (r =0.850,P =0.015) and PVI (r =0.867,P =0.001) before PLR were correlated with △ CI.It was shown by ROC curve that the area under ROC curve (AUC) for SVV fluid responsiveness prediction was 0.948,and cut-off of SVV was 12.4％,the sensitivity was 85.4％,and specificity was 86.6％.The AUC for PVI fluid responsiveness prediction was 0.957,and cut-off was 14.8％,the sensitivity was 87.5％,and specificity was 84.8％.It was higher than other hemodynamic parameters (HR,MAP,CVP).Conclusions PVI and SVV can better predict fluid responsiveness in mechanically ventilating patients with septic shock after PLR.PVI as a new continuous,noninvasive and functional hemodynamic parameter has the same accuracy as SVV.
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Objective To study the changes of pleth variability index (PVI) in patients receiving laparoscopic cholecystectomy under general anesthesia, and to investigate the clinical influencing factors of pre-operation baseline PVI value. Methods Totally 67 patients undergoing laparoscopic cholecystectomy with ASA?-II, aged 18 to 65 years old, were included in the present study. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse oximetry (SpO2), perfusion index (PI), and PVI value were monitored with a Masimo pulse oxygen monitor (Radical-7, USA) after entering the operation room. Fluid expansion with 10 mL/kg of balanced solution was given before the induction. Anesthesia was maintained under total intravenous anesthesia (TIVA) with propofol and remifentanil. Results The average baseline PVI value was (16.8±6.3)% in the patients; then it decreased to (10.3±5.4)% after induction of anesthesia and increased to (21.2±9.5)% after establishment of pneumoperitoneum. The pre-operation baseline PVI value (\[19.2±6.5\] %) of patients <45 years old was significantly higher than that in patients ≥45 years old (\[15.5±5.9\]%, P<0.05%). Male patients had a significantly higher PVI (\[18.8±7.5\]%) value than female patients (\[15.3±4.8\]%, P<0.05). Body mass index (BMI) was not significantly associated with pre-operation baseline PVI. Conclusion The baseline value of PVI is higher than 14%, suggesting insufficient volume load in most of patients. Age and sex are both associated with pre-operation PVI value: male patients and those <45 years old have a higher pre-operation baseline PVI value.