British Journal of Medicine and Medical Research, ISSN: 2231-0614,Vol.: 16, Issue.: 2
Masimo® Plethysmograph Variability Index as a Tool for Assessment of Fluid Responsiveness in Elective Major Abdominal Surgeries
Ahmed M. Essam1, Mohamed Z. Ali1*, Mohamed A. Maher1, Ali M. Mokhtar2, Sohila H. Omar1, Hossam H. El-Sabae1 and Mohamed H. Hafez2 1Department of Anesthesiology, Surgical Intensive Care and Pain Management, Theodor Bilharz Research Institute, Ministry of High Education and Scientific Research, Giza, Egypt. 2Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
Ahmed M. Essam1, Mohamed Z. Ali1*, Mohamed A. Maher1, Ali M. Mokhtar2, Sohila H. Omar1, Hossam H. El-Sabae1 and Mohamed H. Hafez2
1Department of Anesthesiology, Surgical Intensive Care and Pain Management, Theodor Bilharz Research Institute, Ministry of High Education and Scientific Research, Giza, Egypt.
2Department of Anesthesiology, Surgical Intensive Care and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt.
(1) Yinhua Yu, Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, China.
(2) Rakesh Garg, Department of Anaesthesiology, Intensive Care, Pain and Palliative Care, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, India.
(3) Masahiro Hasegawa, Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
(1) Kemal Karakaya, Bulent Ecevit University, Turkey.
(2) Monika Palacios Martínez, Autonomus Metropolitan University, Mexico City, Mexico.
(3) Valery Piacherski, Mogilev Regional Hospital, Mogilev, Belarus.
Complete Peer review History: http://sciencedomain.org/review-history/14859
Background: Maximizing the stroke volume (SV) as measured by Trans-oesophageal Doppler (TED) optimizes preload, & is a goal-directed fluid therapy technique that has been used in a variety of clinical settings. Masimo® Plethysmograph variability Index (PVI) is a reliable, safe & noninvasive tool to guide fluid management. PVI is an automated measure of the dynamic change in the perfusion index (PI) that occurs during a respiratory cycle.
This study was designed to determine whether PVI, measured using finger co-oximetry is an efficient predictor of fluid responsiveness in low-risk patients undergoing elective major abdominal surgery.
Subjects and Methods: 60 ASA I-II patients of either sex, 25-60 years old, undergoing major abdominal surgery were enrolled in this study. A Masimo® Radical-7 Pulse Co-Oximeter probe & a Cardio Q TED probe were applied to each patient. In all patients, a fluid bolus of 500 ml of 130/0.4 tetrastarch colloid solution was administered rapidly via pressurized IV infusion. Maintenance & deficits were calculated routinely. If the SV decreased by 10%, a 250-mL bolus of colloid was given via fast infusion. Patients’ demography, TED-derived measurements: (SV & Flow Time corrected (FTc)), Masimo®-derived measurements: (PVI & PI), HR and MAP were all collected and statistically analyzed. Measurements were done at five minutes post-induction T1, Ten minutes after volume expansion (500 ml colloid) T2, If the SV decreased by 10%, (guided by TED) T3, Then 250 ml colloid is given. Ten minutes after a 250-ml colloid bolus T4.
Results: A significant difference was found in FTc, SV, PI & PVI in T1 vs. T2 & T3 vs. T4 (P=0.001). There was a significant difference in PI & PVI between responders & non-responders for the 1st bolus (P<0.05) and in SV & PVI in subsequent boluses (P<0.01). There was no significant difference between percent changes of SV and PVI at T3 & T4.
Conclusions: Plethysmograph Variability Index (PVI) measured by Masimo® Co-Oximeter is an efficient predictor of fluid responsiveness as SV measured by TED in low risk patients undergoing elective major surgery.
MASIMO®; MASIMO® plethysmograph variability index; trans-oesophageal doppler.
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DOI : 10.9734/BJMMR/2016/26030Review History Comments