The accuracy of Pleth Variability Index for directed fluid optimization in donors in living donor liver transplantation

Ain-Shams Journal of Anesthesiology

Khaled M. Abdou¹  Mohammed M. Kamal¹  Amr M. Hilal Abdou¹ 

[1] Department of Anesthesia, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Abbasia, Lotfy El Sayed Street, 11341, Cairo, Egypt;

关键词: Living donors;    Liver transplantation;    Fluid;    Responsiveness;    Pleth;    Variability;   

DOI  :  10.1186/s42077-021-00199-7

来源: Springer

【 摘 要 】

BackgroundFluid management strongly affects hepatic resection and aims to reduce intraoperative bleeding during living donation. The Pleth Variability Index (PVI) is a tool to assess the fluid responsiveness from the pulse oximeter waveform; we evaluated the efficacy and accuracy of finger PVI compared to pulse pressure variation (PPV) from arterial waveform in predicting the fluid response in donor hepatectomy patients with the guide of non-invasive cardiac output (CO) measurements. We recruited forty patients who were candidates for right lobe hepatectomy for liver transplantation under conventional general anesthesia methods. During periods of intraoperative hypovolemia not affected by surgical manipulation, PVI, PPV, and CO were recorded then compared with definitive values after fluid bolus administration of 3–5 ml/kg aiming to give a 10% increase in CO which classified the patients into responders and non-responders.ResultsBoth PPV and PVI showed a significant drop after fluid bolus dose (P < 0.001) leading to an increase of the CO (P < 0.0001), and the area under the curve was 0.934, 0.842 (95% confidence interval, 0.809 to 0.988, 0.692 to 0.938) and the standard error was 0.0336, 0.124, respectively. Pairwise comparison of PPV and PVI showed non-significant predictive value between the two variables (P = 0.4605); the difference between the two areas was 0.0921 (SE 0125 and 95% CI − 0.152 to 0.337).ConclusionsPVI is an unreliable indicator for fluid response in low-risk donors undergoing right lobe hepatectomy compared to PPV. We need further studies with unbiased PVI monitors in order to implement a non-invasive and safe method for fluid responsiveness.

【 授权许可】

CC BY