March 19, 2020Anesthesiology

Individualized Fluid Management Using the Pleth Variability Index

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Elective orthopedic surgery (n=438). Intervention: Individualized fluid administration using plethysmographic variability index vs. Standard management (target mean arterial pressure >65 mmHg). Primary outcome: Postoperative hospital length of stay (adjusted difference 0.0, 95% CI -0.6 to 0.5, p=0.860).

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Key result

Plethysmographic variability index-guided fluid administration fails to shorten postoperative hospital stay versus standard management.

adjusted difference 0.0
95% CI -0.6 to 0.5
P=0.860
n=438

Why the study?

It was unknown whether individualized fluid administration using a noninvasive plethysmographic variability index could reduce postoperative hospital length of stay and morbidity after intermediate-risk surgery.

Does individualized fluid management using the plethysmographic variability index reduce postoperative hospital length of stay in adult patients having elective orthopedic surgery?

Population

447 adult patients in sinus rhythm undergoing elective orthopedic surgery under general anesthesia

Comparison

Plethysmographic variability index-guided management vs standard management

Design

Multicenter, randomized, nonblinded parallel-group trial

Authors

MFMarc-Olivier FischerLMU Klinikum SLSandrine LemoineUniversité Claude Bernard Lyon 1 BTB. TavernierÉcole Pratique des Hautes Études

Discussion

Member takes

Implication

PVI-guided fluid management did not shorten hospital stay or reduce complications; challenges routine adoption and leaves open questions for higher-risk populations.

Study Design

Type

RCT (n=438)

Blinding

nonblinded

Randomization

parallel-group

Multicenter

Yes

Structured PICO

Does individualized fluid management using the plethysmographic variability index reduce postoperative hospital length of stay in adult patients having elective orthopedic surgery?

Population

438 adult patients in sinus rhythm undergoing elective orthopedic surgery under general anesthesia.

Intervention

Individualized fluid administration guided by a noninvasive plethysmographic variability index (aiming to achieve an index under 13%) during general anesthesia

Comparator

Standard management strategy aimed to maintain a mean arterial pressure above 65 mmHg during general anesthesia

Outcome

Postoperative hospital length of stay decided by surgeons blinded to the group allocation

Main Result

Mean Difference: 0 (95% CI -0.6–0.5)

Absolute Event Rate: 6% vs 6%

p-value: p=0.860

Individualized fluid administration guided by the plethysmographic variability index did not reduce hospital length of stay or complications in intermediate-risk orthopedic surgery patients.

Cite This Study

Fischer et al. (2020) conducted an RCT in Elective orthopedic surgery (n=438). Individualized fluid administration using plethysmographic variability index vs. Standard management (target mean arterial pressure >65 mmHg) was evaluated on Postoperative hospital length of stay (adjusted difference 0.0, 95% CI -0.6 to 0.5, p=0.860). Fluid administration guided by the plethysmographic variability index did not shorten postoperative hospital length of stay compared to standard management (MD 0.0 days; 95% CI -0.6 to 0.5; P=0.860).

synapsesocial.com/papers/6aa42a0e229fb590e7c625bd https://doi.org/10.1097/aln.0000000000003260

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Implication

PVI-guided fluid management did not shorten hospital stay or reduce complications; challenges routine adoption and leaves open questions for higher-risk populations.

Individualized Fluid Management Using the Pleth Variability Index

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Individualized Fluid Management Using the Pleth Variability Index

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider