Julien Florence, Hilly Julie, Sallah Tarik B, Skhiri Alia, Michelet Daphné, Brasher Christopher, Varin Laurent, Nivoche Yves, Dahmani Souhayl
Department of Anesthesia, Intensive care and Pain Management, Robert Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
Paediatr Anaesth. 2013 Jun;23(6):536-46. doi: 10.1111/pan.12139. Epub 2013 Mar 23.
Plethysmographic Variability Index (PVI) has been shown to accurately predict responsiveness to fluid loads in adults. The goal of this study was to evaluate PVI accuracy when predicting fluid responsiveness during noncardiac surgery in children.
Children aged 2-10 years scheduled for noncardiac surgery under general anesthesia were included. PVI was assessed concomitantly with stroke volume index (SVI). A response to fluid load was defined by an SVI increase of more than 15%. A 10 ml·kg(-1) normal saline intravenous fluid challenge was administered before surgical incision and after anesthetic induction. After incision, fluid challenges were administered when SVI values decreased by more than 15% or where judged necessary by the anesthesiologist. Statistical analyses include receiving operator characteristics (ROC) analysis and the determination of gray zone method with an error tolerance of 10%.
Fifty-four patients were included, 97 fluid challenges administered and 45 responses recorded. Area under the curve of ROC curves was 0.85 [0.77-0.93] and 0.8 [0.7-0.89] for baseline PVI and SVI values, respectively. Corresponding gray zone limits were [10-17%] and [22-31 ml·m(-2)], respectively. PVI values exhibited different gray zone limits for pre-incision and postincision fluid challenges, whereas SVI values were comparable. PVI value percentages in the gray zone were 34% overall and 44% for challenges performed after surgical incision.
This study found both PVI and prechallenge SVI to be accurate when used to predict fluid load response during anesthetized noncardiac surgery in children. However, a third of recorded PVI values were inconclusive.
脉搏轮廓变异指数（PVI）已被证明能准确预测成人对液体负荷的反应性。本研究的目的是评估PVI在预测儿童非心脏手术期间液体反应性时的准确性。
纳入计划在全身麻醉下进行非心脏手术的2-10岁儿童。同时评估PVI和每搏量指数（SVI）。液体负荷反应定义为SVI增加超过15%。在手术切口前和麻醉诱导后给予10 ml·kg⁻¹的生理盐水静脉液体冲击。切口后，当SVI值下降超过15%或麻醉医生判断有必要时给予液体冲击。统计分析包括受试者工作特征（ROC）分析和误差容限为10%的灰色区域法测定。
纳入54例患者，给予97次液体冲击，记录到45次反应。基线PVI和SVI值的ROC曲线下面积分别为0.85 [0.77-0.93]和0.8 [0.7-0.89]。相应的灰色区域界限分别为[10-17%]和[22-31 ml·m⁻²]。PVI值在切口前和切口后液体冲击时表现出不同的灰色区域界限，而SVI值具有可比性。灰色区域内PVI值的总体百分比为34%，手术切口后进行的冲击为44%。
本研究发现，PVI和冲击前SVI在用于预测儿童麻醉下非心脏手术期间的液体负荷反应时都是准确的。然而，记录的PVI值中有三分之一是不确定的。
