title: Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients.
abstract: OBJECTIVE
  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 (DeltaP(PLET)) would allow the prediction of changes in cardiac index following volume administration in mechanically ventilated septic patients.
  
  
  METHODS
  Prospective clinical investigation.
  
  
  METHODS
  An 11-bed hospital medical intensive care unit.
  
  
  METHODS
  Twenty-three deeply sedated septic patients mechanically ventilated with tidal volume >or=8 ml/kg and equipped with an arterial catheter and a pulse oximetry plethysmographic sensor.
  
  
  METHODS
  Respiratory changes in pulse pressure (DeltaPP), DeltaP(PLET) and cardiac index (transthoracic Doppler echocardiography) were determined before and after volume infusion of colloids (8 ml/kg).
  
  
  RESULTS
  Twenty-eight volume challenges were performed in 23 patients. Before volume expansion, DeltaPP correlated with DeltaP(PLET) (r2 = 0.71, p<0.001). Changes in cardiac index after volume expansion significantly (p<0.001) correlated with baseline DeltaPP (r2 = 0.76) and DeltaP(PLET) (r2 = 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 DeltaPP value of 12% and a DeltaP(PLET) 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 DeltaPP and DeltaP(PLET) predicted similarly fluid responsiveness.
  
  
  CONCLUSIONS
  The present study found DeltaP(PLET) to be as accurate as DeltaPP for predicting fluid responsiveness in mechanically ventilated septic patients.
authors: Medical Intensive Care Unit, Centre Hospitalier, Belfort, France.
authors: Marc
authors: M
authors: Feissel
authors: Jean-Louis
authors: JL
authors: Teboul
authors: Paolo
authors: P
authors: Merlani
authors: Julio
authors: J
authors: Badie
authors: Jean-Pierre
authors: JP
authors: Faller
authors: Karim
authors: K
authors: Bendjelid
mesh_terms: D000368:Aged; D005440:Fluid Therapy; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial; D018805:Sepsis