title: Prediction of volume responsiveness using pleth variability index in patients undergoing cardiac surgery after cardiopulmonary bypass.
abstract: BACKGROUND
  The pleth variability index (PVI) is derived from analysis of the plethysmographic curve and is considered to be a noninvasive parameter for prediction of volume responsiveness. The aim of our prospective clinical study was to evaluate if volume responsiveness can be predicted by PVI in patients undergoing cardiac surgery after cardiopulmonary bypass.
  
  
  METHODS
  Eighteen patients were prospectively studied. Directly after cardiac surgery, PVI, stroke volume variation (SVV), and cardiac index (CI) were recorded. Colloid infusion (4 ml/kg body weight) was used for volume loading, and volume responsiveness was defined as increase of CI more than 10 %.
  
  
  RESULTS
  SVV and PVI measures were found to be highly correlated at r = 0.80 (p < 0.001). Receiver operating characteristics curve (ROC) analysis resulted in an area under the curve of 0.87 for SVV and 0.95 for PVI, which values did not differ statistically significant from each other (p > 0.05). The optimal threshold value given by ROC analysis was ≥11 % for SVV with a sensitivity and specificity of 100 % and 72.2 %. For PVI, optimal threshold value was ≥16 % with a sensitivity and specificity of 100 % and 88.9 %. Positive and negative predictive values estimating an increase of CI ≥10 % for SVV were 44.4 % and 100 % and 66.7 % and 100 % for PVI.
  
  
  CONCLUSIONS
  For consideration of fluid responsiveness PVI is as accurate as SVV in patients after cardiopulmonary bypass. Methodological limitations such as instable cardiac rhythm after cardiopulmonary bypass and right- or left ventricular impairment seem to be responsible for low specificity and positive predictive values in both parameters PVI and SVV.
authors.affiliation: Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. shaas@uke.de
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haas
authors.forename: Constantin
authors.initials: C
authors.lastname: Trepte
authors.forename: Martin
authors.initials: M
authors.lastname: Hinteregger
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fahje
authors.forename: Bjoern
authors.initials: B
authors.lastname: Sill
authors.forename: Lena
authors.initials: L
authors.lastname: Herich
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D010991:Plethysmography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*