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Plethysmographic variability index (PVI) accuracy in predicting fluid responsiveness in anesthetized children
Florence Julien1, Julie Hilly, Tarik B Sallah
1Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
Insights
The Plethysmographic Variability Index (PVI) accurately predicts fluid responsiveness in children undergoing noncardiac surgery. However, a significant portion of PVI values were inconclusive, indicating a need for further research.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Hemodynamic Monitoring
Background:
- The Plethysmographic Variability Index (PVI) is a validated tool for predicting fluid responsiveness in adults.
- Its accuracy in pediatric populations undergoing noncardiac surgery remains less understood.
Purpose of the Study:
- To evaluate the accuracy of PVI in predicting fluid responsiveness in children aged 2-10 years during noncardiac surgery.
- To compare PVI's predictive performance with Stroke Volume Index (SVI).
Main Methods:
- PVI and SVI were measured simultaneously in 54 children undergoing general anesthesia for noncardiac surgery.
- Fluid responsiveness was defined as a >15% increase in SVI after a 10 ml·kg(-1) saline bolus.
- Statistical analysis included ROC curves and gray zone analysis.
Main Results:
- PVI demonstrated good accuracy (AUC 0.85) in predicting fluid responsiveness.
- A notable gray zone (10-17%) for PVI indicated inconclusive results in 34% of cases, higher post-incision (44%).
- SVI also showed good accuracy (AUC 0.8), with comparable gray zone limits pre- and post-incision.
Conclusions:
- Both PVI and baseline SVI are accurate predictors of fluid load response in anesthetized children during noncardiac surgery.
- A substantial proportion of PVI measurements fell within the gray zone, limiting its clinical utility in certain scenarios.
Introduction:
Plethysmographic Variability Index (PVI) has been shown to accurately predict responsiveness to fluid loads in adults. The goal of this study was to evaluate PVI accuracy when predicting fluid responsiveness during noncardiac surgery in children.
Material And Methods:
Children aged 2-10 years scheduled for noncardiac surgery under general anesthesia were included. PVI was assessed concomitantly with stroke volume index (SVI). A response to fluid load was defined by an SVI increase of more than 15%. A 10 ml·kg(-1) normal saline intravenous fluid challenge was administered before surgical incision and after anesthetic induction. After incision, fluid challenges were administered when SVI values decreased by more than 15% or where judged necessary by the anesthesiologist. Statistical analyses include receiving operator characteristics (ROC) analysis and the determination of gray zone method with an error tolerance of 10%.
Results:
Fifty-four patients were included, 97 fluid challenges administered and 45 responses recorded. Area under the curve of ROC curves was 0.85 [0.77-0.93] and 0.8 [0.7-0.89] for baseline PVI and SVI values, respectively. Corresponding gray zone limits were [10-17%] and [22-31 ml·m(-2)], respectively. PVI values exhibited different gray zone limits for pre-incision and postincision fluid challenges, whereas SVI values were comparable. PVI value percentages in the gray zone were 34% overall and 44% for challenges performed after surgical incision.
Discussion:
This study found both PVI and prechallenge SVI to be accurate when used to predict fluid load response during anesthetized noncardiac surgery in children. However, a third of recorded PVI values were inconclusive.
