Related Experiment Video
Updated: Mar 13, 2026
Standardized Model of Ventricular Fibrillation and Advanced Cardiac Life Support in Swine
Published on: January 30, 2020
Using Pleth Variability as a Triage Tool for Children With Obstructive Airway Disease in a Pediatric Emergency
Ariel Brandwein, Kavita Patel1, Myriam Kline
1Division of Pediatric Emergency Medicine, Children's Hospital of New Jersey, RWJ Barnabas Health, Newark, NJ.
Insights
Pleth variability index (PVI) in children with obstructive airway disease may predict emergency department disposition. Higher PVI indicates a greater likelihood of hospital admission, aiding in triage decisions.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Physiology
- Critical Care
Background:
- Obstructive airway diseases present with variable severity.
- Pulsus paradoxus, a sign of respiratory distress, correlates with illness severity.
- Plethysmography is a method to measure pulsus paradoxus.
Purpose of the Study:
- To determine if plethysmograph (pleth) variability index (PVI) on pediatric emergency department (ED) admission can predict patient disposition.
- To test the hypothesis that higher PVI correlates with increased likelihood of hospital or intensive care unit (ICU) admission.
Main Methods:
- Prospective, single-center study of 117 children (1-18 years) with asthma or reactive airway disease.
- Calculation of PVI from initial plethysmography tracings.
- Recording of ED disposition: discharge, floor admission, or ICU admission.
Main Results:
- Median PVI was 0.27 for discharged patients, 0.29 for floor admissions, and 0.56 for ICU admissions.
- A significant difference in PVI was observed between the disposition groups (P = 0.0087).
- Higher PVI values were associated with increased likelihood of hospital admission.
Conclusions:
- PVI shows potential as a useful triage tool for children with obstructive airway disease in the ED.
- Further research is needed to validate PVI's predictive capability for response to bronchodilator therapy.
Objectives:
Patients with obstructive airway disease have varying degrees of pulsus paradoxus that correlate with illness severity. Pulsus paradoxus can be measured using plethysmography. We investigated whether plethysmograph (pleth) variability on admission to the pediatric emergency department (ED) could predict patient disposition. We hypothesized that patients with a larger pleth variability would have a higher likelihood of being admitted to a general pediatrics unit or the intensive care unit (ICU).
Methods:
We conducted a prospective single-center study of children aged 1 to 18 years who presented to a pediatric ED with a diagnosis of asthma or reactive airway disease. The pleth variability index (PVI) was calculated from their initial plethysmography tracing. Disposition from the ED was recorded as discharge, admission to the floor, or admission to the ICU.
Results:
A total of 117 patients were included in our study. Forty-eight patients were discharged home, 61 were admitted to the floor, and 8 were admitted to the ICU. The median PVI for each of these groups was 0.27 (interquartile range [IQR], 0.19-0.39) for discharges, 0.29 (IQR, 0.20-0.44) for patients admitted to the floor, and 0.56 (IQR, 0.35-0.70) for patients admitted to the ICU. A Kruskal-Wallis test demonstrated a significant difference in the PVI between each of the groups (P = 0.0087).
Conclusions:
Our results suggest that PVI may be a useful tool in the triage of children who present to the ED with obstructive airway disease. Further studies should aim to assess the validity of PVI in predicting the response to bronchodilator therapy during the course of a patient's hospitalization.
More Related Videos
08:12Calculating Heart Rate Variability from ECG Data from Youth with Cerebral Palsy During Active Video Game Sessions
Published on: June 5, 2019
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Related Concept Videos
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is...
01:26Respiratory Volumes and Capacities I
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:23Acute Respiratory Failure-IV
01:21Cardiopulmonary Resuscitation I: Adult