Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults: a systematic review and meta-analysis

PurposeTo systematically review the accuracy of the variation in pulse oxymetry plethysmographic waveform amplitude (∆POP) and the Pleth Variability Index (PVI) as predictors of fluid responsiveness in mechanically ventilated adults.MethodsMEDLINE, Scopus and the Cochrane Database of Systematic Reviews were screened for clinical studies in which the accuracy of ∆POP/PVI in predicting the hemodynamic response to a subsequent fluid bolus had been investigated. Random-effects meta-analysis was used to summarize the results. Data were stratified according to the amount of fluid bolus (large vs. small) and to the study index (∆POP vs. PVI).ResultsTen studies in 233 patients were included in this meta-analysis. All patients were in normal sinus rhythm. The pooled area under the receiver operating characteristic curve (AUC) for identification of fluid responders was 0.85 [95 % confidence interval (CI) 0.79–0.92]. Pooled sensitivity and specificity were 0.80 (95 % CI 0.74–0.85) and 0.76 (0.68–0.82), respectively. No heterogeneity was found within studies with the same amount of fluid bolus, nor between studies on ∆POP and those on PVI. The AUC was significantly larger in studies with a large bolus amount than in those with a small bolus [0.92 (95 % CI 0.87–0.96) vs. 0.70 (0.62–0.79); p < 0.0001]. Sensitivity and specificity were also higher in studies with a large bolus [0.84 (95 % CI 0.77–0.90) vs. 0.72 (0.60–0.82) (small bolus), p = 0.08 and 0.86 (95 % CI 0.75–0.93) vs. 0.68 (0.56–0.77) (small bolus), p = 0.02], respectively.ConclusionsBased on our meta-analysis, we conclude that ∆POP and PVI are equally effective for predicting fluid responsiveness in ventilated adult patients in sinus rhythm. Prediction is more accurate when a large fluid bolus is administered.

[1]  M. Cannesson,et al.  Influence of the site of measurement on the ability of plethysmographic variability index to predict fluid responsiveness. , 2011, British journal of anaesthesia.

[2]  Maxime Cannesson,et al.  Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients , 2005, Critical care.

[3]  M. Steinfath,et al.  Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index , 2011, Acta anaesthesiologica Scandinavica.

[4]  K. Shelley,et al.  Oscillations in the plethysmographic waveform amplitude: phenomenon hides behind artifacts. , 2009, Anesthesiology.

[5]  P. Bossuyt,et al.  BMC Medical Research Methodology , 2002 .

[6]  M. Cannesson,et al.  Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers , 2008, Critical care.

[7]  M. Antonelli,et al.  Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies , 2010, Intensive Care Medicine.

[8]  Maxime Cannesson,et al.  Respiratory Variations in Pulse Oximetry Plethysmographic Waveform Amplitude to Predict Fluid Responsiveness in the Operating Room , 2007 .

[9]  Maxime Cannesson,et al.  Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms? , 2008, Anesthesia and analgesia.

[10]  M. Cannesson,et al.  Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. , 2008, British journal of anaesthesia.

[11]  Stefan Moritz,et al.  Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery , 2009, European journal of anaesthesiology.

[12]  Douglas G Altman,et al.  Interaction revisited: the difference between two estimates , 2003, BMJ : British Medical Journal.

[13]  G. Natalini,et al.  Arterial Versus Plethysmographic Dynamic Indices to Test Responsiveness for Testing Fluid Administration in Hypotensive Patients: A Clinical Trial , 2006, Anesthesia and analgesia.

[14]  B. Riou,et al.  Relation between pulse oximetry plethysmographic waveform amplitude induced by passive leg raising and cardiac index in spontaneously breathing subjects. , 2010, The American journal of emergency medicine.

[15]  Michael Baram,et al.  Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. , 2008, Chest.

[16]  B. Partridge,et al.  Use of Pulse Oximetry as a Noninvasive Indicator of Intravascular Volume Status , 1987, Journal of Clinical Monitoring.

[17]  A. Perel,et al.  Stroke Volume Variation as a Predictor of Fluid Responsiveness in Patients Undergoing Brain Surgery , 2001, Anesthesia and analgesia.

[18]  Maxime Cannesson,et al.  Using ventilation-induced plethysmographic variations to optimize patient fluid status , 2008, Current opinion in anaesthesiology.

[19]  J. Hisdal,et al.  Poor Agreement between Respiratory Variations in Pulse Oximetry Photoplethysmographic Waveform Amplitude and Pulse Pressure in Intensive Care Unit Patients , 2008, Anesthesiology.

[20]  K. Yamaura,et al.  Evaluation of Finger and Forehead Pulse Oximeters during Mild Hypothermic Cardiopulmonary Bypass , 2007, Journal of Clinical Monitoring and Computing.

[21]  M. Ghobashy,et al.  Analysis of the Ear Pulse Oximeter Waveform , 2006, Journal of Clinical Monitoring and Computing.

[22]  J. Teboul,et al.  Pulse oximeter as a sensor of fluid responsiveness: do we have our finger on the best solution? , 2005, Critical care.

[23]  F. Gianfagna,et al.  Quality assessment in meta-analysis , 2006, Italian Journal of Public Health.

[24]  M. Levy,et al.  Hemodynamic monitoring in shock and implications for management , 2007, Intensive Care Medicine.

[25]  D. Chemla,et al.  Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. , 2000, American journal of respiratory and critical care medicine.

[26]  J. C. Dorlas,et al.  Photo-electric plethysmography as a monitoring device in anaesthesia. Application and interpretation. , 1985, British journal of anaesthesia.

[27]  F. Sztark,et al.  Impact of norepinephrine on the relationship between pleth variability index and pulse pressure variations in ICU adult patients , 2011, Critical care.

[28]  R. Pizov,et al.  Pulse oximetry plethysmographic waveform during changes in blood volume. , 1999, British journal of anaesthesia.

[29]  A. Awad,et al.  The Use of Joint Time Frequency Analysis to Quantify the Effect of Ventilation on the Pulse Oximeter Waveform , 2006, Journal of Clinical Monitoring and Computing.

[30]  J. Vincent,et al.  How can the response to volume expansion in patients with spontaneous respiratory movements be predicted? , 2006, Critical care.

[31]  A. Awad,et al.  Different Responses of Ear and Finger Pulse Oximeter Wave Form to Cold Pressor Test , 2001, Anesthesia and analgesia.

[32]  F. Pruvot,et al.  Non-invasive prediction of fluid responsiveness during major hepatic surgery. , 2006, British journal of anaesthesia.

[33]  K. Shelley.  Photoplethysmography: Beyond the Calculation of Arterial Oxygen Saturation and Heart Rate , 2007, Anesthesia and analgesia.

[34]  M. Antonelli,et al.  Functional hemodynamic monitoring and dynamic indices of fluid responsiveness. , 2008, Minerva anestesiologica.

[35]  P. Durnez,et al.  Ventilation-Induced Plethysmographic Variations Predict Fluid Responsiveness in Ventilated Postoperative Cardiac Surgery Patients , 2007, Anesthesia and analgesia.

[36]  K. Bendjelid.  The pulse oximetry plethysmographic curve revisited , 2008, Current opinion in critical care.

[37]  G. Lebuffe,et al.  Systolic Pressure Variation as a Guide to Fluid Therapy in Patients with Sepsis‐induced Hypotension , 1998, Anesthesiology.

[38]  J. Vincent,et al.  Pulse pressure variations to predict fluid responsiveness: influence of tidal volume , 2005, Intensive Care Medicine.

[39]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[40]  Julianto Hood,et al.  Pleth Variability Index to Predict Fluid Responsiveness in Colorectal Surgery , 2011, Anesthesia and analgesia.

[41]  R. Cavallazzi,et al.  Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: A systematic review of the literature* , 2009, Critical care medicine.

[42]  Karim Bendjelid,et al.  Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients , 2007, Intensive Care Medicine.

[43]  S. A. Landsverk,et al.  Photoplethysmographic and pulse pressure variations during abdominal surgery , 2011, Acta anaesthesiologica Scandinavica.

[44]  Javier Zamora,et al.  Meta-DiSc : a software for meta-analysis of test accuracy data , 2015 .