Key result
The Pleth Variability Index predicted preload responsiveness in mechanically ventilated patients with an area under the curve of 0.82 (95% CI 0.79-0.85).
Why the study?
Does the Pleth Variability Index reliably predict preload responsiveness in mechanically ventilated patients?
Meta-Analysis (n=975)
Does the Pleth Variability Index reliably predict preload responsiveness in mechanically ventilated patients?
PVI has moderate reliability for predicting preload responsiveness in mechanically ventilated patients, performing best in non-surgical ICU patients.
Answers are grounded in this paper and cite their sources.
PVI offers moderate accuracy for preload responsiveness in ventilated patients; supports selective ICU use while extending pooled diagnostic data for targeted validation.
Background: Goal-directed volume expansion is increasingly used for fluid management in mechanically ventilated patients. The Pleth Variability Index (PVI) has been shown to reliably predict preload responsiveness; however, a lot of research on PVI has been published recently, and update of the meta-analysis needs to be completed. Methods: We searched PUBMED, EMBASE, Cochrane Library, Web of Science (updated to November 7, 2018) and the associated references. We also contacted relevant authors and researchers. Results: Twenty-five studies with 975 patients were included in this meta-analysis. All patients were mechanically ventilated. The area under the curve (AUC) of receiver operating characteristics (ROC) to predict preload responsiveness in patients was 0.82 (95% confidence interval (CI) 0.79 - 0.85). The pooled sensitivity was 0.77 (95% CI 0.67-0.85) and the pooled specificity was 0.77 (95% CI 0.71-0.82). The results of subgroup of patients without undergoing surgery (AUC =0.86, Youden index =0.65) and the results of subgroup of patients in ICU (AUC =0.89, Youden index =0.67) were reliable. Conclusion: The reliability of the PVI is limited, but the PVI can play an important role in bedside monitoring for mechanically ventilated patients who are not undergoing surgery. Patients who are expanded with colloid may be more suitable for PVI.
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Liu et al. (2019) conducted a meta-analysis in mechanically ventilated patients (n=975). Pleth Variability Index (PVI) was evaluated on preload responsiveness (AUC 0.82, 95% CI 0.79-0.85). The Pleth Variability Index predicted preload responsiveness in mechanically ventilated patients with an area under the curve of 0.82 (95% CI 0.79-0.85).
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