Felippe Vitor Alves, Codeceira Roberta, Irigaray Maria, Sckaff Maria, Wegner Bruno, Nascimento Tatiana, Darcy Carlos, Dutra Lucas, Santiago Bruno, Buchmann Julia, Lessa Marcos Adriano
Department of Anesthesiology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil.
School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
J Clin Monit Comput. 2025 Aug 8. doi: 10.1007/s10877-025-01334-7.
Optimal intraoperative fluid management is essential to improve surgical outcomes and reduce complications. The Pleth Variability Index (PVI), a dynamic and non-invasive indicator of fluid responsiveness, has been proposed as a tool for goal-directed fluid management. This systematic review and meta-analysis aimed to evaluate the effectiveness of PVI-guided fluid therapy compared to conventional fluid management (CFM) in non-cardiac surgeries. A comprehensive search of PubMed, Embase, and Cochrane databases up to January 2024 identified eligible studies. Primary outcomes included total intraoperative fluid volume and crystalloid administration. Secondary outcomes included hemodynamic parameters, renal function markers, acid-base balance, and hospital length of stay (LOS). Random-effects models were applied, and subgroup and sensitivity analyses were performed. Nine studies comprising 1,105 patients were included. Compared to conventional fluid management, PVI-guided therapy significantly reduced total fluid volume (mean difference [MD] - 761.23 mL; 95% CI - 1267.42 to - 255.03) and crystalloid administration (MD - 655.05 mL; 95% CI - 1096.48 to - 213.62), without significant differences in colloid use, urine output, norepinephrine requirement, arterial pressure, acid-base balance, or LOS. Subgroup analysis of abdominal surgeries confirmed the observed reduction in fluid volumes. PVI-guided fluid management allows for a more restrictive and individualized approach without compromising hemodynamic or metabolic stability. While the heterogeneity across studies limits generalizability, these findings support the clinical value of PVI as a non-invasive tool for perioperative fluid optimization, especially in settings where invasive monitoring is not feasible. Further trials are needed to evaluate its impact on long-term outcomes.
优化术中液体管理对于改善手术效果和减少并发症至关重要。脉搏变异指数（PVI）是一种动态且无创的液体反应性指标，已被提议作为目标导向性液体管理的工具。本系统评价和荟萃分析旨在评估与传统液体管理（CFM）相比，PVI引导的液体治疗在非心脏手术中的有效性。对截至2024年1月的PubMed、Embase和Cochrane数据库进行全面检索，确定了符合条件的研究。主要结局包括术中总液体量和晶体液输注量。次要结局包括血流动力学参数、肾功能指标、酸碱平衡和住院时间（LOS）。应用随机效应模型，并进行亚组分析和敏感性分析。纳入了9项研究，共1105例患者。与传统液体管理相比，PVI引导的治疗显著减少了总液体量（平均差[MD] -761.23 mL；95%CI -1267.42至-255.03）和晶体液输注量（MD -655.05 mL；95%CI -1096.48至-213.62），在胶体使用、尿量、去甲肾上腺素需求量、动脉压、酸碱平衡或住院时间方面无显著差异。腹部手术的亚组分析证实了观察到的液体量减少。PVI引导的液体管理允许采用更严格和个性化的方法，而不影响血流动力学或代谢稳定性。虽然各研究间的异质性限制了可推广性，但这些发现支持了PVI作为围手术期液体优化的无创工具的临床价值，特别是在无法进行有创监测的情况下。需要进一步的试验来评估其对长期结局的影响。
