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TECHNOLOGY, COMPUTING, AND SIMULATION

Does the Pleth Variability Index Indicate the Respiratory-Induced Variation in the Plethysmogram and Arterial Pressure Waveforms?

From the Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital and Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France.

Address correspondence and reprint requests to Maxime Cannesson, MD, Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 Avenue du Doyen Lépine, 69500 Bron, France. Address e-mail to maxime_cannesson{at}hotmail.com.

BACKGROUND: Respiratory variations in the pulse oximeter plethysmographic waveform amplitude (POP) are sensitive to changes in preload and can predict fluid responsiveness in mechanically ventilated patients. However, they cannot be easily calculated from a bedside monitor. Pleth variability index (PVI, Masimo Corp., Irvine, CA) is a new algorithm that automatically calculates POP. The aim of our study was to test the ability of this new device to automatically and continuously monitor POP.

METHODS: Twenty-five patients were studied after induction of general anesthesia. PVI automatically and continuously calculates the respiratory variations in the plethysmography waveform amplitude (perfusion index). Data (mean arterial blood pressure, central venous pressure, respiratory variations in arterial pulse pressure, POP, and PVI) were recorded at baseline in anti-Trendelenburg position and, finally, in Trendelenburg position.

RESULTS: There was a significant relationship between PVI and POP (r = 0.92; P < 0.05). Over the 75 measurements, 42 (56%) presented a POP value >13%. A PVI threshold value of 11.5% was able to discriminate between POP >13% and POP 13% with a sensitivity of 93% and a specificity of 97%. Area under the curve for PVI to predict POP >13% was 0.990 ± 0.07.

CONCLUSION: This study is the first to demonstrate the ability of PVI, an index automatically derived from the pulse oximeter waveform analysis, to automatically and continuously monitor POP. This new index has potential clinical applications for noninvasive fluid responsiveness monitoring.

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