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A pilot study of the pleth variability index as an indicator of volume-responsive hypotension in newborn infants during surgery

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Abstract

Purpose

The aim of this pilot study was to evaluate the diagnostic value of pleth variability index (PVI) to predict fluid responsiveness in newborn infants during surgery.

Methods

PVI was continuously recorded in 29 mechanically ventilated newborn infants during surgery, and episodes of clinically indicated volume expansion (VE) (≥10 ml/kg in ≤15 min) administration were evaluated. The upper limit of the reference range for PVI in mechanically ventilated newborns was defined by the 95th percentile of all PVI values from hemodynamically stable infants.

Results

The upper limit of the reference range of PVI was 18 %. One hundred and three VEs were evaluated in 58 sufficient VE size (SVES) episodes and 16 insufficient initial VE size (IVES) episodes requiring repeated VE; all but one fulfilled criteria of volume-responsive hypotension (VRH). The median (interquartile range) PVI value during arterial hypotension in the 73 episodes with VRH was 23 % (20–25 %); postvolume PVI was 16 % (13–18 %). In 63 of 73 VRH episodes, during-hypotension PVI values were >18 % (86 % sensitivity for VRH). The median intermediate PVI, measured between VE in IVES episodes, was significantly higher than post-VE PVI in SVES episodes [18 % (16–21 % vs. 16 % (13–18 %].

Conclusion

This preliminary evaluation shows that PVI may indicate VRH in newborn infants during surgery.

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Abbreviations

IVES:

Insufficient initial volume expansion size

PI:

Perfusion index

ΔPOP:

Variations in pulse oximetry plethysmographic waveform amplitude

PP:

Pulse pressure

PVI:

Pleth variability index

SVES:

Sufficient volume expansion size

VE:

Volume expansion

VRH:

Volume-responsive hypotension

MABP:

Mean arterial blood pressure

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Acknowledgments

Masimo Corp, CA, USA, kindly provided pulse oximetry and sensors but did not have any input on trial design, data analysis, and reporting.

Conflict of interest

Masimo provided pulse oximetry and sensors. Since the conduct and completion of the study reported herein, Axel Franz has collected clinical data for Masimo and has been granted equipment for a large clinical study by Masimo. All other authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Soyhan Bagci, Nicole Müller, Andreas Müller, Peter Bartmann & Axel R. Franz

  2. Department of Pediatric Surgery, University of Bonn, Adenauerallee 119, 53113, Bonn, Germany

    Andreas Heydweiller

  3. Center for Pediatric Clinical Studies, Department of Neonatology, Children’s Hospital, University of Tuebingen, 72076, Tübingen, Germany

    Axel R. Franz

Authors
  1. Soyhan Bagci
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  2. Nicole Müller
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  3. Andreas Müller
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  6. Axel R. Franz
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Correspondence to Soyhan Bagci.

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Bagci, S., Müller, N., Müller, A. et al. A pilot study of the pleth variability index as an indicator of volume-responsive hypotension in newborn infants during surgery. J Anesth 27, 192–198 (2013). https://doi.org/10.1007/s00540-012-1511-6

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  • DOI: https://doi.org/10.1007/s00540-012-1511-6

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