Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 4/2011

Open Access 01-08-2011 | Research

Impact of norepinephrine on the relationship between pleth variability index and pulse pressure variations in ICU adult patients

Authors: Matthieu Biais, Vincent Cottenceau, Laurent Petit, Françoise Masson, Jean-François Cochard, François Sztark

Published in: Critical Care | Issue 4/2011

Login to get access

Abstract

Introduction

Pleth Variability Index (PVI) is an automated and continuous calculation of respiratory variations in the perfusion index. PVI correlates well with respiratory variations in pulse pressure (ΔPP) and is able to predict fluid responsiveness in the operating room. ICU patients may receive vasopressive drugs, which modify vascular tone and could affect PVI assessment. We hypothesized that the correlation between PVI and ΔPP and the ability of PVI to identify patients with ΔPP > 13% is dependent on norepinephrine (NE) use.

Methods

67 consecutive mechanically ventilated patients in the ICU were prospectively included. Three were excluded. The administration and dosage of NE, heart rate, mean arterial pressure, PVI and ΔPP were measured simultaneously.

Results

In all patients, the correlation between PVI and ΔPP was weak (r2 = 0.21; p = 0.001). 23 patients exhibited a ΔPP > 13%. A PVI > 11% was able to identify patients with a ΔPP > 13% with a sensitivity of 70% (95% confidence interval: 47%-87%) and a specificity of 71% (95% confidence interval: 54%-84%). The area under the curve was 0.80 ± 0.06. 35 patients (53%) received norepinephrine (NE(+)). In NE(+) patients, PVI and ΔPP were not correlated (r2 = 0.04, p > 0.05) and a PVI > 10% was able to identify patients with a ΔPP > 13% with a sensitivity of 58% (95% confidence interval: 28%-85%) and a specificity of 61% (95% confidence interval:39%-80%). The area under the ROC (receiver operating characteristics) curve was 0.69 ± 0.01. In contrast, NE(-) patients exhibited a correlation between PVI and ΔPP (r2 = 0.52; p < 0.001) and a PVI > 10% was able to identify patients with a ΔPP > 13% with a sensitivity of 100% (95% confidence interval: 71%-100%) and a specificity of 72% (95% confidence interval: 49%-90%). The area under the ROC curve was 0.93 ± 0.06 for NE(-) patients and was significantly higher than the area under the ROC curve for NE(+) patients (p = 0.02).

Conclusions

Our results suggest that in mechanically ventilated adult patients, NE alters the correlation between PVI and ΔPP and the ability of PVI to predict ΔPP > 13% in ICU patients.
Appendix
Available only for authorised users
Literature
1.
Michard F: Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005, 103: 419-428. 10.1097/00000542-200508000-00026PubMedCrossRef
2.
Michard F, Teboul JL: Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 2002, 121: 2000-2008. 10.1378/chest.121.6.2000PubMedCrossRef
3.
Osman D, Ridel C, Ray P, Monnet X, Anguel N, Richard C, Teboul JL: Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge. Crit Care Med 2007, 35: 64-68. 10.1097/01.CCM.0000249851.94101.4FPubMedCrossRef
4.
Biais M, Nouette-Gaulain K, Cottenceau V, Revel P, Sztark F: Uncalibrated pulse contour-derived stroke volume variation predicts fluid responsiveness in mechanically ventilated patients undergoing liver transplantation. Br J Anaesth 2008, 101: 761-768. 10.1093/bja/aen277PubMedCrossRef
5.
Feissel M, Michard F, Faller JP, Teboul JL: The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 2004, 30: 1834-1837.PubMedCrossRef
6.
Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL: Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 2001, 119: 867-873. 10.1378/chest.119.3.867PubMedCrossRef
7.
Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL: Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000, 162: 134-138.PubMedCrossRef
8.
Tavernier B, Makhotine O, Lebuffe G, Dupont J, Scherpereel P: Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998, 89: 1313-1321. 10.1097/00000542-199812000-00007PubMedCrossRef
9.
Cannesson M, Desebbe O, Lehot JJ: Fluid responsiveness assessment using the pulse oxymeter waveform: not yet ready for prime time. Anesth Analg 2007, 104: 1598-1599. 10.1213/01.ane.0000260463.40639.7fPubMedCrossRef
10.
De Backer D, Heenen S, Piagnerelli M, Koch M, Vincent JL: Pulse pressure variations to predict fluid responsiveness: influence of tidal volume. Intensive Care Med 2005, 31: 517-523. 10.1007/s00134-005-2586-4PubMedCrossRef
11.
De Backer D, Taccone FS, Holsten R, Ibrahimi F, Vincent JL: Influence of respiratory rate on stroke volume variation in mechanically ventilated patients. Anesthesiology 2009, 110: 1092-1097. 10.1097/ALN.0b013e31819db2a1PubMedCrossRef
12.
Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F, Galy C, Slama M, Dupont H: Assessing fluid responsiveness in critically ill patients: False-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med 2009, 37: 2570-2575. 10.1097/CCM.0b013e3181a380a3PubMedCrossRef
13.
Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky MR, Teboul JL: Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 2006, 34: 1402-1407. 10.1097/01.CCM.0000215453.11735.06PubMedCrossRef
14.
Wyler von Ballmoos M, Takala J, Roeck M, Porta F, Tueller D, Ganter CC, Schroder R, Bracht H, Baenziger B, Jakob SM: Pulse-pressure variation and hemodynamic response in patients with elevated pulmonary artery pressure: a clinical study. Crit Care 2010, 14: R111. 10.1186/cc9060PubMedPubMedCentralCrossRef
15.
Durand P, Chevret L, Essouri S, Haas V, Devictor D: Respiratory variations in aortic blood flow predict fluid responsiveness in ventilated children. Intensive Care Med 2008, 34: 888-894. 10.1007/s00134-008-1021-zPubMedCrossRef
16.
Cannesson M, Attof Y, Rosamel P, Desebbe O, Joseph P, Metton O, Bastien O, Lehot JJ: Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room. Anesthesiology 2007, 106: 1105-1111. 10.1097/01.anes.0000267593.72744.20PubMedCrossRef
17.
Natalini G, Rosano A, Taranto M, Faggian B, Vittorielli E, Bernardini A: Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg 2006, 103: 1478-1484. 10.1213/01.ane.0000246811.88524.75PubMedCrossRef
18.
Delerme S, Castro S, Freund Y, Nazeyrollas P, Josse MO, Madonna-Py B, Rouff E, Riou B, Ray P: Relation between pulse oximetry plethysmographic waveform amplitude induced by passive leg raising and cardiac index in spontaneously breathing subjects. Am J Emerg Med 2010, 28: 505-510. 10.1016/j.ajem.2009.03.023PubMedCrossRef
19.
Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B, Ray P: Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers. Am J Emerg Med 2007, 25: 637-642. 10.1016/j.ajem.2006.11.035PubMedCrossRef
20.
Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bendjelid K: Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med 2007, 33: 993-999. 10.1007/s00134-007-0602-6PubMedCrossRef
21.
Landsverk SA, Hoiseth LO, Kvandal P, Hisdal J, Skare O, Kirkeboen KA: Poor agreement between respiratory variations in pulse oximetry photoplethysmographic waveform amplitude and pulse pressure in intensive care unit patients. Anesthesiology 2008, 109: 849-855. 10.1097/ALN.0b013e3181895f9fPubMedCrossRef
22.
Cannesson M, Delannoy B, Morand A, Rosamel P, Attof Y, Bastien O, Lehot JJ: Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg 2008, 106: 1189-1194. 10.1213/ane.0b013e318167ab1fPubMedCrossRef
23.
Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, Lehot JJ: Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth 2008, 101: 200-206. 10.1093/bja/aen133PubMedCrossRef
24.
Desebbe O, Boucau C, Farhat F, Bastien O, Lehot JJ, Cannesson M: The ability of pleth variability index to predict the hemodynamic effects of positive end-expiratory pressure in mechanically ventilated patients under general anesthesia. Anesth Analg 2010, 110: 792-798. 10.1213/ANE.0b013e3181cd6d06PubMedCrossRef
25.
Lima A, Bakker J: Noninvasive monitoring of peripheral perfusion. Intensive Care Med 2005, 31: 1316-1326. 10.1007/s00134-005-2790-2PubMedCrossRef
26.
Lima AP, Beelen P, Bakker J: Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med 2002, 30: 1210-1213. 10.1097/00003246-200206000-00006PubMedCrossRef
27.
Devlin JW, Boleski G, Mlynarek M, Nerenz DR, Peterson E, Jankowski M, Horst HM, Zarowitz BJ: Motor Activity Assessment Scale: a valid and reliable sedation scale for use with mechanically ventilated patients in an adult surgical intensive care unit. Crit Care Med 1999, 27: 1271-1275. 10.1097/00003246-199907000-00008PubMedCrossRef
28.
Pinsky MR: Using ventilation-induced aortic pressure and flow variation to diagnose preload responsiveness. Intensive Care Med 2004, 30: 1008-1010. 10.1007/s00134-004-2208-6PubMedCrossRef
29.
Vieillard-Baron A, Chergui K, Augarde R, Prin S, Page B, Beauchet A, Jardin F: Cyclic changes in arterial pulse during respiratory support revisited by Doppler echocardiography. Am J Respir Crit Care Med 2003, 168: 671-676. 10.1164/rccm.200301-135OCPubMedCrossRef
30.
Michard F: Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005, 103: 419-428. 10.1097/00000542-200508000-00026PubMedCrossRef
31.
Scheer B, Perel A, Pfeiffer UJ: Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring in anaesthesia and intensive care medicine. Crit Care 2002, 6: 199-204. 10.1186/cc1489PubMedPubMedCentralCrossRef
32.
Cohen A, Reyes R, Kirk M, Fulks RM: Osler's nodes, pseudoaneurysm formation, and sepsis complicating percutaneous radial artery cannulation. Crit Care Med 1984, 12: 1078-1079. 10.1097/00003246-198412000-00017PubMedCrossRef
33.
34.
McEllistrem RF, O'Toole DP, Keane P: Post-cannulation radial artery aneurysm--a rare complication. Can J Anaesth 1990, 37: 907-909. 10.1007/BF03006633PubMedCrossRef
35.
Slogoff S, Keats AS, Arlund C: On the safety of radial artery cannulation. Anesthesiology 1983, 59: 42-47. 10.1097/00000542-198307000-00008PubMedCrossRef
36.
Cannesson M, Besnard C, Durand PG, Bohe J, Jacques D: Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients. Crit Care 2005, 9: R562-568. 10.1186/cc3799PubMedPubMedCentralCrossRef
37.
Loupec T, Nanadoumgar H, Frasca D, Petitpas F, Laksiri L, Baudouin D, Debaene B, Dahyot-Fizelier C, Mimoz O: Pleth variability index predicts fluid responsiveness in critically ill patients. Crit Care Med 2010, 39: 294-299.CrossRef
38.
Broch O, Bein B, Gruenewald M, Hocker J, Schottler J, Meybohm P, Steinfath M, Renner J: Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index. Acta Anaesthesiol Scand 2011, 55: 686-693. 10.1111/j.1399-6576.2011.02435.xPubMedCrossRef
39.
Shelley KH, Jablonka DH, Awad AA, Stout RG, Rezkanna H, Silverman DG: What is the best site for measuring the effect of ventilation on the pulse oximeter waveform? Anesth Analg 2006, 103: 372-377. 10.1213/01.ane.0000222477.67637.17PubMedCrossRef
40.
Marik PE, Cavallazzi R, Vasu T, Hirani A: Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009, 37: 2642-2647. 10.1097/CCM.0b013e3181a590daPubMedCrossRef
41.
Cheatham ML, Malbrain ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations. Intensive Care Med 2007, 33: 951-962. 10.1007/s00134-007-0592-4PubMedCrossRef
42.
Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppaniemi A, Olvera C, Ivatury R, D'Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A: Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006, 32: 1722-1732. 10.1007/s00134-006-0349-5PubMedCrossRef
Metadata
Title
Impact of norepinephrine on the relationship between pleth variability index and pulse pressure variations in ICU adult patients
Authors
Matthieu Biais
Vincent Cottenceau
Laurent Petit
Françoise Masson
Jean-François Cochard
François Sztark
Publication date
01-08-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10310

Other articles of this Issue 4/2011

Critical Care 4/2011 Go to the issue

Research

sRAGE in diabetic and non-diabetic critically ill patients: effects of intensive insulin therapy

Commentary

Appropriate antibiotic dosing in severe sepsis and acute renal failure: factors to consider

Research

Plasma cell-free DNA in patients needing mechanical ventilation

Research

Elevated red cell distribution width predicts poor outcome in young patients with community acquired pneumonia

Research

Mild-stretch mechanical ventilation upregulates toll-like receptor 2 and sensitizes the lung to bacterial lipopeptide

Research

Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: An observational study