title: Plethysmographic variation index predicts fluid responsiveness in ventilated patients in the early phase of septic shock in the emergency department: a pilot study.
abstract: OBJECTIVE
  Feasibility study examining whether plethysmographic variability index (PVI) can predict fluid responsiveness in mechanically ventilated patients in the early phase of septic shock in the emergency department.
  
  
  METHODS
  Monocentric, prospective, observational study that included 31 mechanically ventilated and sedated patients with septic shock in whom volume expansion was planned. The patients were equipped with a pulse oximeter that automatically calculated and displayed PVI. The intervention consisted in infusing 8 mL/kg of hydroxylethyl starch over a 20-minute period. Before and after intervention, we recorded PVI and measured the aortic velocity-time integral (VTIao) using transthoracic echocardiography. Responders were defined as patients who increased their VTIao by 15% or higher after fluid infusion.
  
  
  RESULTS
  Sixteen patients were classified as responders, and 15 as nonresponders. Mean PVI values before intervention were significantly higher in responders vs nonresponders (30%±9% vs 8%±5%, P<.001). Plethysmographic variability index values before intervention were correlated with percent changes in VTIao induced by intervention (R2=0.67; P<.001). A PVI threshold value of 19% discriminates responders from nonresponders with a sensitivity of 94% and a specificity of 87% (area under the curve, 0.97; P<.001).
  
  
  CONCLUSIONS
  Our study suggests that PVI is a feasible and interesting method to predict fluid responsiveness in early phase septic shock patients in the emergency department.
authors.affiliation: Service de Réanimation, Maladies Infectieuses, Centre Hospitalier de Belfort-Montbéliard, Hôpital de Belfort, Belfort, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Feissel
authors.forename: Rachid
authors.initials: R
authors.lastname: Kalakhy
authors.forename: Pierre
authors.initials: P
authors.lastname: Banwarth
authors.forename: Julio
authors.initials: J
authors.lastname: Badie
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pavon
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Faller
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D008297:Male; D010092:Oximetry; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000627:therapeutic use; D010991:Plethysmography; D011446:Prospective Studies; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: Fluid resuscitation; Heart-lung interactions; Mechanical ventilation; Plethysmographic variation index; Septic shock; Volume responsiveness