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Agreement between Pleth Variability Index and oesophageal Doppler to predict fluid responsiveness
Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
Sodertalje Hospital, Sweden.
Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping. Linköping University, Faculty of Medicine and Health Sciences.
2016 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 60, no 2, 183-192 p.Article in journal (Refereed) PublishedText
Abstract [en]

Background: Optimisation of stroke volume using oesophageal Doppler is an established technique to guide intraoperative fluid therapy. The method has practical limitations and therefore alternative indices of fluid responsiveness, such as ventilator-induced variation in the pulse oximetric signal (Pleth Variability Index (PVI)) could be considered. We hypothesised that both methods predict fluid responsiveness in a similar way. Methods: Seventy-five patients scheduled for open major abdominal surgery were randomised to fluid optimisation using fluid bolus algorithms based on either PVI (n = 35) or Doppler (n = 39). All patients were monitored with both methods; the non-guiding method was blind. Primary endpoint was the concordance between the methods to predict fluid responsiveness. We also analysed the ability of each method to predict a stroke volume increase >= 10% after a fluid bolus, as well as the accumulated intraoperative bolus fluid volume. Results: PVI indicated a need for fluid in one-third of the situations when Doppler did so, Cohens kappa = 0.03. A fluid bolus indicated by the PVI algorithm increased stroke volume by >= 10% in half the situations. The same was found for the Doppler algorithm. The mean total bolus volume given was 878 ml when the fluid management was governed by PVI compared to 826 ml with Doppler (P = 0.71). Conclusion: PVI-and Doppler-based stroke volume optimisations agreed poorly, which did not affect the amount of fluid administered. None of the algorithms showed a good ability to predict fluid responsiveness. Our results do not support the fluid responsiveness concept.

Place, publisher, year, edition, pages
WILEY-BLACKWELL , 2016. Vol. 60, no 2, 183-192 p.
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Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-124622DOI: 10.1111/aas.12632ISI: 000368139700006PubMedID: 26373826OAI: oai:DiVA.org:liu-124622DiVA: diva2:901805
Note

Funding Agencies|Department of Anaesthesiology and Intensive Care, Linkoping University Hospital; County Council of Ostergotland

Available from: 2016-02-09 Created: 2016-02-08 Last updated: 2016-02-09

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Bahlmann, HansNilsson, Lena
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Department of Medical and Health SciencesDepartment of Anaesthesiology and Intensive Care in LinköpingFaculty of Medicine and Health SciencesDepartment of Anaesthesiology and Intensive Care in Norrköping
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Acta Anaesthesiologica Scandinavica
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