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Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients

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In septic patients, reliable non-invasive predictors of fluid responsiveness are needed. We hypothesised that the respiratory changes in the amplitude of the plethysmographic pulse wave (ΔPPLET) would allow the prediction of changes in cardiac index following volume administration in mechanically ventilated septic patients.


Prospective clinical investigation.


An 11-bed hospital medical intensive care unit.


Twenty-three deeply sedated septic patients mechanically ventilated with tidal volume ≥ 8 ml/kg and equipped with an arterial catheter and a pulse oximetry plethysmographic sensor.


Respiratory changes in pulse pressure (ΔPP), ΔPPLET and cardiac index (transthoracic Doppler echocardiography) were determined before and after volume infusion of colloids (8 ml/kg).

Measurements and main results

Twenty-eight volume challenges were performed in 23 patients. Before volume expansion, ΔPP correlated with ΔPPLET (r 2 = 0.71, p < 0.001). Changes in cardiac index after volume expansion significantly (p < 0.001) correlated with baseline ΔPP (r 2 = 0.76) and ΔPPLET (r 2 = 0.50). The patients were defined as responders to fluid challenge when cardiac index increased by at least 15% after the fluid challenge. Such an event occurred 18 times. Before volume challenge, a ΔPP value of 12% and a ΔPPLET value of 14% allowed discrimination between responders and non-responders with sensitivity of 100% and 94% respectively and specificity of 70% and 80% respectively. Comparison of areas under the receiver operator characteristic curves showed that ΔPP and ΔPPLET predicted similarly fluid responsiveness.


The present study found ΔPPLET to be as accurate as ΔPP for predicting fluid responsiveness in mechanically ventilated septic patients.

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  1. Bendjelid K, Romand JA (2003) Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 29:352–360

    Article  PubMed  Google Scholar 

  2. Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008

    Article  PubMed  Google Scholar 

  3. Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL (2001) Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 119:867–873

    Article  PubMed  CAS  Google Scholar 

  4. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138

    PubMed  CAS  Google Scholar 

  5. Reuter DA, Felbinger TW, Schmidt C, Kilger E, Goedje O, Lamm P, Goetz AE (2002) Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 28:392–398

    Article  PubMed  Google Scholar 

  6. Awad AA, Ghobashy MA, Stout RG, Silverman DG, Shelley KH (2001) How does the plethysmogram derived from the pulse oximeter relate to arterial blood pressure in coronary artery bypass graft patients? Anesth Analg 93:1466–1471

    Article  PubMed  CAS  Google Scholar 

  7. Murray WB, Foster PA (1996) The peripheral pulse wave: information overlooked. J Clin Monit 12:365–377

    Article  PubMed  CAS  Google Scholar 

  8. Shelley KH, Murray WB, Chang D (1997) Arterial-pulse oximetry loops: a new method of monitoring vascular tone. J Clin Monit 13:223–228

    Article  PubMed  CAS  Google Scholar 

  9. Cannesson M, Besnard C, Durand PG, Bohe J, Jacques D (2005) Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients. Crit Care 9:R562–568

    Article  PubMed  Google Scholar 

  10. Alexander CM, Teller LE, Gross JB (1989) Principles of pulse oximetry: theoretical and practical considerations. Anesth Analg 68:368–376

    Article  PubMed  CAS  Google Scholar 

  11. Awad AA, Stout RG, Ghobashy MA, Rezkanna HA, Silverman DG, Shelley KH (2006) Analysis of the ear pulse oximeter waveform. J Clin Monit Comput 20:175–184

    Article  PubMed  Google Scholar 

  12. Monnet X, Lamia B, Teboul JL (2005) Pulse oximeter as a sensor of fluid responsiveness: do we have our finger on the best solution? Crit Care 9:429–430

    Article  PubMed  Google Scholar 

  13. Shamir M, Eidelman LA, Floman Y, Kaplan L, Pizov R (1999) Pulse oximetry plethysmographic waveform during changes in blood volume. Br J Anaesth 82:178–181

    PubMed  CAS  Google Scholar 

  14. Cannesson M, Desebbe O, Hachemi M, Jacques D, Bastien O, Lehot JJ (2007) Respiratory variations in pulse oximeter waveform amplitude are influenced by venous return in mechanically ventilated patients under general anaesthesia. Eur J Anaesthesiol 24:245–251

    Article  PubMed  CAS  Google Scholar 

  15. Natalini G, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A (2006) Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg 103:1478–1484

    Article  PubMed  Google Scholar 

  16. De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL (2005) Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 31:517–523

    Article  PubMed  Google Scholar 

  17. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538

    PubMed  Google Scholar 

  18. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone–alphadolone. Br Med J 2:656–659

    Article  PubMed  CAS  Google Scholar 

  19. Preisman S, Kogan S, Berkenstadt H, Perel A (2005) Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the Respiratory Systolic Variation Test and static preload indicators. Br J Anaesth 95:746–755

    Article  PubMed  CAS  Google Scholar 

  20. Stetz CW, Miller RG, Kelly GE, Raffin TA (1982) Reliability of the thermodilution method in the determination of cardiac output in clinical practice. Am Rev Respir Dis 126:1001–1004

    PubMed  CAS  Google Scholar 

  21. Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843

    PubMed  CAS  Google Scholar 

  22. Feissel M, Badie J, Merlani PG, Faller JP, Bendjelid K (2005) Pre-ejection period variations predict the fluid responsiveness of septic ventilated patients. Crit Care Med 33:2534–2539

    Article  PubMed  Google Scholar 

  23. Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, Jardin F (2004) Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med 30:1734–1739

    PubMed  Google Scholar 

  24. Duperret S, Lhuillier F, Piriou V, Vivier E, Metton O, Branche P, Annat G, Bendjelid K, Viale JP (2007) Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs. Intensive Care Med 33:163–171

    Article  PubMed  Google Scholar 

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Correspondence to Karim Bendjelid.

Additional information

This work was performed in the Medical Intensive Care Unit, Centre Hospitalier, Belfort, France.

Funding: No external funding

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Feissel, M., Teboul, JL., Merlani, P. et al. Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med 33, 993–999 (2007).

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