Publication:

Plethysmographic variability index as a tool to assess fluid responsiveness in critically ill patients: a correlation study with inferior vena cava distensibility index

Background In critically ill patients in the intensive care unit (ICU), early aggressive fluid replacement is the cornerstone of resuscitation. Traditionally employed static measures of fluid responsiveness have a poor predictive value. It is therefore imperative to employ dynamic measures of fluid responsiveness that take into account the heart lung interactions in the mechanically ventilated patients. The main objective of this study was to evaluate the reliability of one such non-invasive dynamic index: Plethysmographic variability index (PVI) compared to the widely employed Inferior vena cava distensibility index (dIVC).

Methods Seventy-six adult patients admitted at a tertiary care mixed ICU, who developed hypotension (MAP 15.5% discriminated between responders and non-responders with a 90.2% sensitivity and 75% specificity with an AUC of 0.84 (0.72-0.96) (p<0.001).

Conclusions There is good correlation between PVI values and measured dIVC values at baseline and following a fluid challenge. Thus, PVI may be an acceptable, real time, continuous, surrogate measure of fluid responsiveness in critically ill patients.