title: Peripheral Perfusion Index Predicts Hypotension during Fluid Withdrawal by Continuous Veno-Venous Hemofiltration in Critically Ill Patients.
abstract: OBJECTIVE
  Peripheral perfusion may predict harmful hypovolemic hypotension during fluid withdrawal by continuous veno-venous hemofiltration (CVVH) in critically ill patients with acute kidney injury.
  
  
  METHODS
  Twenty-three critically ill AKI patients were subjected to progressive fluid withdrawal. Systemic hemodynamics and peripheral perfusion index (PPI) by pulse oximetry, forearm-to-fingertip skin temperature gradient (Tskin-diff) and tissue oxygen saturation (StO2, near infra-red spectroscopy) were measured.
  
  
  RESULTS
  Most hemodynamic values decreased with fluid withdrawal, particularly in the hypotensive group, except for stroke volume (SV) and cardiac output, which decreased to a great extent in the non-hypotensive patients. Increases in systemic vascular resistance (SVR) were less in hypotension. Baseline pulse pressure and PPI were lower in hypotensive (n = 10) than non-hypotensive patients and subsequent PPI values paralleled SV decreases. A baseline PPI ≤0.82 AU predicted hypotension with a sensitivity of 70%, and a specificity of 92% (AUC 0.80 ± 0.11, p = 0.004).
  
  
  CONCLUSIONS
  Progressive fluid withdrawal during CVVH is poorly tolerated in patients with less increases in SVR. The occurrence of hypotension can be predicted by low baseline PPI.
authors.affiliation: Erasmus MC University Medical Center, Departments of Intensive Care, Rotterdam, The Netherlands.
authors.forename: Eva
authors.initials: E
authors.lastname: Klijn
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: Michel E
authors.initials: ME
authors.lastname: van Genderen
authors.forename: Michiel
authors.initials: M
authors.lastname: Betjes
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
authors.forename: Jasper
authors.initials: J
authors.lastname: van Bommel
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve