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Pleth Variability Index to Assess Course of Illness in Children with Asthma

Audrey Uong1, Ariel Brandwein2, Colin Crilly3

  • 1Division of Pediatric Hospital Medicine, Children's Hospital at Montefiore/Albert Einstein School of Medicine, Bronx, New York.

The Journal of Emergency Medicine
|July 31, 2018
PubMed

Insights

Pleth Variability Index (PVI) did not correlate with asthma severity or patient disposition in the pediatric emergency department. Further research is needed to determine PVI

Area of Science:

  • Pediatric Emergency Medicine
  • Critical Care
  • Respiratory Physiology

Background:

  • Status asthmaticus (SA) is a frequent pediatric emergency department (ED) admission.
  • Assessing asthma severity in the ED is challenging, with inconsistent results from adjunctive tools.
  • Pulsus paradoxus (PP) correlates with asthma severity, and Pleth Variability Index (PVI) is a surrogate measure of PP.

Purpose of the Study:

  • To investigate the correlation between PVI at triage and patient disposition from the ED.
  • To evaluate PVI as an adjunctive tool for assessing asthma severity in pediatric SA.

Main Methods:

  • Recruited children aged 2-18 years with SA presenting to a pediatric ED.
  • Measured PVI, Respiratory Severity Score, and vital signs at triage and 2 hours into ED stay.
  • Utilized Masimo Radical-7 monitor for PVI measurements.

Main Results:

  • Thirty-eight patients were recruited; 27 discharged, 10 admitted to floor, 1 to ICU.
  • PVI values at triage did not correlate with ED disposition (p = 0.63).
  • No statistically significant patterns were demonstrated when trending PVI changes after 2 hours of ED therapy.

Conclusions:

  • PVI did not demonstrate a correlation with clinical course in pediatric asthmatics.
  • PVI might be more relevant in critically ill children or with continuous monitoring.
  • Additional studies are necessary to clarify PVI's role in SA severity assessment.
Abstract

Keywords:
PVIPleth Variability Indexasthmaasthma exacerbationpediatric emergency departmentpediatric emergency medicinepediatricspulsus paradoxusstatus asthmaticustriage

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