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.
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.
['Fischer|Marc-Olivier|MO|', 'Pelissier|Arnaud|A|', 'Bohadana|Dan|D|', 'Gérard|Jean-Louis|JL|', 'Hanouz|Jean-Luc|JL|', 'Fellahi|Jean-Luc|JL|']
D000368:Aged D062186:Arterial Pressure D001794:Blood Pressure D006348:Cardiac Surgical Procedures D002315:Cardiopulmonary Bypass D005260:Female D005385:Fingers D005440:Fluid Therapy D006801:Humans D008297:Male D008875:Middle Aged D016343:Monitoring, Intraoperative D010991:Plethysmography D011237:Predictive Value of Tests D011674:Pulse D012372:ROC Curve D012039:Regional Blood Flow D012044:Regression Analysis D015203:Reproducibility of Results
intravenous fluid challenge cardiac surgery cardiopulmonary bypass pulse pressure variation fluid responsiveness