Pleth Variability Index or Inferior Vena Cava Collapsibility Index? Prospective Observational Study in Volume Control...

Area of Science:

• Critical Care Medicine
• Nephrology
• Cardiovascular Physiology

Background:

• Acute kidney injury (AKI) necessitates careful fluid management, balancing risks of under- and over-resuscitation.
• Inferior Vena Cava Collapsibility Index (IVCCI) is a common but limited tool for fluid assessment in AKI.
• The utility of the non-invasive Pleth Variability Index (PVI) in AKI fluid management is not well-established.

Purpose of the Study:

• To compare the efficacy of PVI and IVCCI in assessing fluid responsiveness in AKI patients.
• To evaluate the predictive value of PVI for in-hospital mortality in AKI.

Main Methods:

• Prospective observational study of 50 adult AKI patients in an emergency department.
• Sequential fluid resuscitation with 1000 mL and 2000 mL of isotonic saline.
• Measurement of PVI, IVCCI, MAP, SpO2, PI, and SI at baseline and post-fluid bolus.

Main Results:

• PVI showed significant, dose-responsive decreases post-fluid administration, superior to IVCCI, MAP, PI, SpO2, and SI (p < 0.001).
• Baseline PVI was a significant predictor of mortality (AUC: 0.821, p < 0.001).
• IVCCI and PI had comparable reliability but were less sensitive to volume changes than PVI.

Conclusions:

• PVI is a sensitive, non-invasive marker for fluid responsiveness in non-intubated AKI patients.
• Baseline PVI may serve as an early prognostic indicator for in-hospital mortality in AKI.
• Further multicenter studies are required to validate PVI's role in AKI fluid management.