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The ability of pulse oximetry-derived peripheral perfusion index to detect fluid responsiveness in patients with septic shock

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Abstract

Background

Fluid challenge test is a widely used method for the detection of fluid responsiveness in acute circulatory failure. However, detection of the patient's response to the fluid challenge requires monitoring of cardiac output which is not feasible in many settings. We investigated whether the changes in the pulse oximetry-derived peripheral perfusion index (PPI), as a non-invasive surrogate of cardiac output, can detect fluid responsiveness using the fluid challenge test or not.

Methods

We prospectively enrolled 58 patients with septic shock on norepinephrine infusion. Fluid challenge test, using 200 mL crystalloid solution, was performed in all study subjects. All patients received an additional 300 mL crystalloid infusion to confirm fluid responsiveness. Velocity time integral (VTI) (using transthoracic echocardiography), and PPI were measured at the baseline, after 200 mL fluid challenge, and after completion of 500 mL crystalloids. Fluid responsiveness was defined by 10% increase in the VTI after completion of the 500 mL. The predictive ability of ∆PPI [Calculated as (PPI after 200 mL − baseline PPI)/baseline PPI] to detect fluid responders was obtained using the receiver operating characteristic curve.

Results

Forty-two patients (74%) were fluid responders; in whom, the mean arterial pressure, the central venous pressure, the VTI, and the PPI increased after fluid administration compared to the baseline values. ∆PPI showed moderate ability to detect fluid responders [area under receiver operating characteristic curve (95% confidence interval) 0.82 (0.70–0.91), sensitivity 76%, specificity 80%, positive predictive value 92%, negative predictive value 54%, cutoff value ≥ 5%]. There was a significant correlation between ∆PPI and ∆VTI induced by the fluid challenge.

Conclusion

∆PPI showed moderate ability to detect fluid responsiveness in patients with septic shock on norepinephrine infusion. Increased PPI after 200 mL crystalloid challenge can detect fluid responsiveness with a positive predictive value of 92%; however, failure of the PPI to increase does not exclude fluid responsiveness.

Clinical trial identifier

NCT03805321. Date of registration: 15 January 2019. Clinical trial registration URL: https://clinicaltrials.gov/ct2/show/NCT03805321?term=ahmed+hasanin&rank=9.

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Abbreviations

APACHE:

Acute physiology and chronic health evaluation

AUROC:

Area under receiver operating characteristic

CI:

Confidence interval

CO2 gap:

Central venous-arterial CO2 gap

PPI:

Peripheral perfusion index

ScVO2 :

Central venous oxygen saturation

SPSS:

Statistical package for social science

VTI:

Velocity time integral

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Acknowledgements

We would like to acknowledge all the residents and assistant lecturers in our department who helped with this research.

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The authors declare that they did not receive any fund for this work.

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt

    Ahmed Hasanin, Nadia Karam, Ahmed M. Mukhtar & Sara F. Habib

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  1. Ahmed Hasanin
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  2. Nadia Karam
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  3. Ahmed M. Mukhtar
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  4. Sara F. Habib
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Correspondence to Ahmed Hasanin.

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Hasanin, A., Karam, N., Mukhtar, A.M. et al. The ability of pulse oximetry-derived peripheral perfusion index to detect fluid responsiveness in patients with septic shock. J Anesth 35, 254–261 (2021). https://doi.org/10.1007/s00540-021-02908-w

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  • DOI: https://doi.org/10.1007/s00540-021-02908-w

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