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Use of the pleth variability index in children with obstructive respiratory disease
Gülşah Demir1, Emel Berksoy1, Şefika Bardak1
1Department of Pediatric Emergency, University Health Sciences, Tepecik Research and Training Hospital, Izmir, Turkey.
Insights
The Pleth Variability Index (PVI) can help assess obstructive respiratory disease severity in children. Higher PVI values indicate more severe disease and hospitalization risk, aiding emergency department triage.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Physiology
- Critical Care Monitoring
Background:
- Obstructive respiratory tract diseases are common in children, with pulsus paradoxus (PP) indicating severity.
- The Pleth Variability Index (PVI) reflects respiratory-induced perfusion changes and may noninvasively estimate PP.
- Accurate, rapid assessment of disease severity is crucial for pediatric emergency department triage.
Purpose of the Study:
- To investigate the role of PVI measurements in assessing obstructive respiratory tract disease severity in children.
- To evaluate PVI changes before and after bronchodilator therapy in pediatric patients.
- To determine if PVI can predict hospitalization or need for intensive care.
Main Methods:
- A prospective, single-center study included 133 children (aged 2-18) with obstructive respiratory symptoms.
- PVI and Pulmonary Index Score (PIS) were recorded at triage and post-bronchodilator therapy.
- Patients were grouped by clinical severity and disposition (discharge, admission, PICU).
Main Results:
- Pre- and post-treatment PVI values were significantly higher in severe disease groups and in hospitalized patients (p < 0.001).
- PVI values decreased significantly after bronchodilator therapy across all severity groups (p < 0.001).
- ROC analysis showed high accuracy for PVI in predicting severe disease and hospitalization (AUCs 0.843-0.940).
Conclusions:
- Automated PVI measurement is a noninvasive, rapid, and objective tool for emergency department triage of pediatric asthma or reactive airway disease.
- PVI effectively differentiates disease severity and predicts hospitalization risk in children with obstructive respiratory conditions.
- PVI offers a valuable adjunct to clinical assessment in pediatric respiratory emergencies.
Introduction:
The phenomenon of pulsus paradoxus (PP) develops at varying rates in relation to the severity of the disease in obstructive respiratory tract disease. The Pleth Variability Index (PVI) is the measurement value of perfusion index changes that occur with ventilation, which are determined during at least one respiratory cycle. Therefore, noninvasive measurement of PVI can help in the measurement of PP. The current study aims to determine the role of PVI measurements before and after bronchodilator therapy during admission to the hospital in children with obstructive respiratory tract disease.
Methods:
Age, gender, Pulmonary Index Score (PIS), and PVI data of patients aged 2-18 years who applied to the pediatric emergency department with signs of obstructive respiratory tract disease were recorded in triage. The PVI and PIS scores of the patients, who were divided into three groups according to their clinical severity scores, were recorded before and after bronchodilator treatment, and they were compared to the PVI values according to the disposition results.
Results:
A total of 133 patients were included in this prospective, single-center study. The PVI values before and after treatment were significantly higher in patients with severe disease compared to the mild and moderate groups (p < 0.001). Post-treatment PVI values were significantly lower than pre-treatment values in all clinical severity groups (p < 0.001). While a total of 95 (71.43%) patients were discharged from the emergency department, 31 (23.31%) patients were admitted to the relevant department, and seven (5.26%) patients were admitted to the pediatric intensive care unit. The PVI values before and after treatment were significantly higher in the hospitalized group compared to the group discharged from the emergency department (p < 0.001). The areas under the ROCs were 0.940, 0.865, and 0.843 for the PVI measurements in patients with severe disease, moderate disease, and hospitalization (p< 0.001).
Conclusions:
Automated PVI measurement can be used as a noninvasive, rapid, and objective tool in the emergency department triage of patients admitted to the pediatric emergency department with signs of asthma attack or reactive respiratory tract disease.
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