What is the clinical evidence from this study?

Study design: Observational. Population: Healthy volunteers (n=25). Intervention: Passive leg raising (PLR) vs. Baseline (semirecumbent position). Primary outcome: Prediction of fluid responsiveness (cardiac output increase >12.5%) using Pleth Variability Index (PVI) (AUC 0.734, p=<0.05).

March 6, 2008Critical CareOpen Access

Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers

Q: What are the key findings of this study?

In spontaneously breathing volunteers, a Pleth Variability Index threshold above 19% was a weak but significant predictor of fluid responsiveness to passive leg raising, yielding an AUC of 0.734.

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Key result

In spontaneously breathing volunteers, a Pleth Variability Index threshold above 19% was a weak but significant predictor of fluid responsiveness to passive leg raising, yielding an AUC of 0.734.

Why the study?

Does Pleth Variability Index (PVI) predict fluid responsiveness induced by passive leg raising in spontaneously breathing volunteers?

Population

25 spontaneously breathing volunteers with no previous arterial hypertension, known cardiac disease, active…

Comparison

Passive leg raising of 45 degrees with the trunk… vs Baseline semirecumbent position (45 degrees).

Design

Cohort, Observer analyzing pulse oximeter waveforms was blinded to other…

Follow-up

Immediate (during positional changes)

Authors

GKG. KellerInfirmerie Protestante ECEmmanuel CassarCentre Hospitalier Annecy Genevois ODOlivier DesebbeUniversity of California, Los Angeles

Discussion

Member takes

Implication

PVI should not yet guide fluid decisions in spontaneously breathing patients; hypothesis-generating for validation in critically ill cohorts.

Study Design

Type

Observational (n=25)

Blinding

Single-blind (observer blinded to hemodynamic data)

Multicenter

Structured PICO

Does Pleth Variability Index (PVI) predict fluid responsiveness induced by passive leg raising in spontaneously breathing volunteers?

Population

25 healthy spontaneously breathing volunteers aged 21 to 55 years, free of cardiac disease or arrhythmias, underwent passive leg raising to assess hemodynamic changes.

Intervention

Passive leg raising (PLR) of 45 degrees with the trunk lowered in the supine position for 5 minutes.

Comparator

Baseline semirecumbent position (45 degrees).

Outcome

Ability of Pleth Variability Index (PVI) to detect hemodynamic changes and predict fluid responsiveness (>12.5% increase in cardiac output) induced by passive leg raising.surrogate

Main Result

Effect estimate: AUC 0.734

p-value: p=<0.05

PVI can detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers, but it is a weak predictor of fluid responsiveness.

Limitations

Did not conduct real volume expansion, relying instead on passive leg raising.
Cannot be used in patients with cardiac arrhythmias.
Did not assess systemic vascular resistance, which influences pulse oximeter waveform amplitude.
Small sample size of 25 volunteers.
Did not conduct real volume expansion
Cannot be used in patients with cardiac arrhythmias
Did not assess systemic vascular resistance

Cite This Study

Keller et al. (2008) conducted an observational in Healthy volunteers (n=25). Passive leg raising (PLR) vs. Baseline (semirecumbent position) was evaluated on Prediction of fluid responsiveness (cardiac output increase >12.5%) using Pleth Variability Index (PVI) (AUC 0.734, p=<0.05). In spontaneously breathing volunteers, a Pleth Variability Index threshold above 19% was a weak but significant predictor of fluid responsiveness to passive leg raising, yielding an AUC of 0.734.

synapsesocial.com/papers/6a6f4fce26a7f98052dc030a https://doi.org/10.1186/cc6822

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Implication

PVI should not yet guide fluid decisions in spontaneously breathing patients; hypothesis-generating for validation in critically ill cohorts.

Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider