Document Detail


Prediction of Responsiveness to an Intravenous Fluid Challenge in Patients After Cardiac Surgery with Cardiopulmonary Bypass: A Comparison Between Arterial Pulse Pressure Variation and Digital Plethysmographic Variability Index.
MedLine Citation:
PMID:  23992654     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Arterial pulse pressure variation (PPV) and digital plethysmographic variability index (PVI) have been proposed to predict fluid responsiveness during anesthesia and in critically ill patients. The present study aimed to compare the clinical utility of PPV and PVI in predicting fluid responsiveness after elective cardiac surgery.
DESIGN: A prospective observational study.
SETTING: A university hospital.
PARTICIPANTS: Eighty-seven adult patients.
INTERVENTIONS: Admission to the intensive care unit after cardiac surgery. Investigation before and after fluid challenge.
MEASUREMENTS AND MAIN RESULTS: The discrimination of both PPV and PVI in predicting fluid responsiveness was compared by using areas under the receiver operating characteristics curves (ROCAUC). Sensibility analyses were conducted after exclusion of patients with a low perfusion index, patients receiving norepinephrine, and patients with right ventricular dysfunction. Fifty-seven (71%) patients were responders and twenty-three (29%) were nonresponders. ROCAUC were 0.73 [95% CI: 0.63-0.83] versus 0.60 [95% CI: 0.48-0.71] for PPV and PVI in the whole cohort of patients, respectively (p = 0.020). The inconclusive class of responses included 47 (59%) and 62 (77%) patients, respectively (p = 0.010); whereas the discrimination of PVI remained low whatever the subgroup of patients, the discrimination of PPV markedly increased in patients without perfusion index≤1.3 (ROCAUC = 0.83 [95% CI: 0.68-0.93]) and in patients without right ventricular dysfunction (ROCAUC = 0.85 [95% CI: 0.67-0.95]).
CONCLUSIONS: PVI is not discriminant and probably inaccurate to predict fluid responsiveness after elective cardiac surgery. PPV could be of potential interest after exclusion of patients with a low perfusion index and right ventricular dysfunction.
Authors:
Marc-Olivier Fischer; Arnaud Pelissier; Dan Bohadana; Jean-Louis Gérard; Jean-Luc Hanouz; Jean-Luc Fellahi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-8-28
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  -     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-9-2     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Caen, France; Department of Cardiology, CHU de Caen, Caen, France. Electronic address: fischer-mo@chu-caen.fr.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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