Izvorni znanstveni članak
https://doi.org/10.22514/SV132.112017.14
Comparıng pulse pressure varıatıon and pleth varıabılıty ındex in the semı-recumbent and trendelenburg posıtıon ın crıtıcally ıll septıc patıents
MEHMET TURAN INAL
; Department of Anesthesiology and Reanimation, Trakya University, Faculty of Medicine, Edirne, Turkey
F. NESRIN TURAN
SELMAN KARADAYI
BEYHAN KARAMANLIOGLU
DILEK MEMIŞ
Sažetak
Introduction. Dynamic tests for predicting
fluid responsiveness have generated
increased interest in recent years. One of
these tests, pulse pressure variation (PPV),
is a parameter calculated from respiratory
variations of pulse pressure. Another test,
pleth variability index (PVI), is based on
respiratory variations of the perfusion index
and can be measured non-invasively
by pulse oximeter. Previous studies have
shown that both tests are valuable in determining
fluid responsiveness.
Methods. In this observational prospective
study, our aim was to compare the PVI and
PPV in order to identify a convenient tool
for determining fluid responsiveness. Our
study was performed in a surgical and reanimation
intensive care unit. We enrolled
one hundred mechanically ventilated adult
patients diagnosed with sepsis. Exclusion
criteria included brain death, spontaneous
breathing, cardiac arrhythmia, and
impaired peripheral circulation. We measured
the PPV by arterial monitorization
and the PVI by using Masimo Radical 7 in
the 45° semi-recumbent position (SP) and
then 15° Trendelenbug position (TP). We
performed correlation and ROC analysis
using a >13% fluid responsiveness cut-off
value for the PPV and >14% for the PVI.
Results. Between the SP and the TP, we did
not observe significant decreases in PPV
(from 14.17 ± 10.57 to 12.66 ± 9.64; p >
0.05), while we did observe significant decreases
in PVI (from 21.91 ± 13.99 to 20.46
± 14.12; p < 0.05). The PPV fluid responsiveness
cut-off value in the SP and TP was
20% (78.95% sensitivity, 77.05% specificity)
and 18% (76.67% sensitivity, 72.46%
specificity), respectively. The PVI fluid
responsiveness cut-off value in the SP and
TP was 20% (80.49% sensitivity, 81.03%
specificity) and 16% (81.25% sensitivity,
62.69% specificity), respectively. The area
under the ROC of the PPV and PVI was
0.843 and 0.858 in the SP, respectively, and
0.760 and 0.747 in the TP, respectively. The
PPV and PVI were correlated in the SP (r
= 0.578; p = 0.001) and the TP (r = 0.517;
p = 0.001).
Conclusions. Our results showed that the
PPV and PVI were correlated independent
of position change in sepsis patients. Both
tests appear to be equivalently reliable.
However, the ability of the PPV and PVI
to predict fluid responsiveness decreased
in the TP in our study.
Ključne riječi
pulse pressure variation; pleth variability index; fluid responsiveness; sepsis
Hrčak ID:
190622
URI
Datum izdavanja:
12.12.2017.
Posjeta: 860 *