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Comparison of pulse pressure variation and pleth variability index in the prone position in pediatric patients under
Sang-Hwan Ji1, In-Kyung Song2, Young-Eun Jang1
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Pulse pressure variation (PPV) and pleth variability index (PVI) showed no significant correlation in children under two undergoing prone surgery. Further research is needed to understand their relationship with fluid responsiveness in this age group.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Hemodynamic Monitoring
Background:
- Accurate assessment of intravascular volume status is crucial for pediatric patients during anesthesia.
- Pulse pressure variation (PPV) and pleth variability index (PVI) are commonly used to evaluate fluid responsiveness.
- The study focuses on children under two years old undergoing surgery in the prone position.
Purpose of the Study:
- To compare the reliability of PPV and PVI in assessing intravascular volume status in pediatric patients.
- To investigate the correlation between PPV and PVI in children aged less than two years during prone surgery.
- To evaluate the impact of prone positioning on PPV and PVI measurements.
Main Methods:
- A total of 27 children under two years old were enrolled in the study.
- PPV and PVI were measured simultaneously before and after prone positioning.
- Bland-Altman analysis was used to assess bias and correlation between PPV and PVI.
Main Results:
- There was no significant correlation observed between PPV and PVI in the studied pediatric population.
- The bias between PPV and PVI was -2.2%, with wide limits of agreement (-18.8% to 14.5%).
- Neither PPV nor PVI showed significant changes before and after the position change from supine to prone.
Conclusions:
- PPV and PVI are not significantly correlated in young children undergoing surgery in the prone position.
- Further research is required to establish the relationship between PVI, PPV, and fluid responsiveness using cardiac output estimation in this age group.
- The findings highlight the need for careful interpretation of these parameters in pediatric patients in the prone position.
Background:
The assessment of intravascular volume status is very important especially in children during anesthesia. Pulse pressure variation (PPV) and pleth variability index (PVI) are well known parameters for assessing intravascular volume status and fluid responsiveness. We compared PPV and PVI for children aged less than two years who underwent surgery in the prone position.
Methods:
A total of 27 children were enrolled. We measured PPV and PVI at the same limb during surgery before and after changing the patients' position from supine to prone. We then compared PPV and PVI at each period using Bland-Altman plot for bias between the two parameters and for any correlation. We also examined the difference between before and after the position change for each parameter, along with peak inspiratory pressure, heart rate and mean blood pressure.
Results:
The bias between PPV and PVI was -2.2% with a 95% limits of agreement of -18.8% to 14.5%, not showing significant correlation at any period. Both PPV and PVI showed no significant difference before and after the position change.
Conclusions:
No significant correlation between PVI and PPV was observed in children undergoing surgery in the prone position. Further studies relating PVI, PPV, and fluid responsiveness via adequate cardiac output estimation in children aged less than 2 years are required.
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