Evaluation of Peroperative Fluid Balance with PVI (Pleth Variability Index) and Correlation with NIRS (Near Infrared Spectroscopy)

Yıl 2024, Cilt: 3 Sayı: 3, 115 - 123, 23.09.2024

Cana Melis Çelik Sermin Altunbaş , Yücel Karaman

https://doi.org/10.57221/izmirtip.1494247

Öz

Abstract

Aim: The aim of this study was to evaluate the fluid therapy given in major abdominal surgeries with PVI (pleth variability index) and to monitor its correlation with NIRS (cerebral oximetry).

Materials and methods: In this prospective, observational study, 86 patients with ASA physical status score I-II-III and undergoing major abdominal surgery were included. All patients underwent cerebral oximetry (right-left cerebral oxygen saturation by near-infrared spectroscopy) and PVI (pleth variability index) monitoring before anesthesia in addition to standard ASA monitoring. Patients who underwent arterial cannulation were included in the study. Demographic and hemodynamic data, right/left cerebral oxygen saturation values and PVI values were recorded at baseline before induction, 5 minutes after induction, 1, 2, 3, 4, 5 hours and at the end of surgery.

Results: In our study, right and left cerebral oxygen saturation was correlated with hemoglobin, etCO2 and pCO2. Similar correlation was found between etCO2 and PVI, but PVI was not correlated with hemoglobin. PVI was correlated with systolic arterial pressure and basal right cerebral oxygen saturation.

Conclution: We concluded that evaluation of fluid therapy by PVI in major abdominal surgeries is affected by factors such as hypothermia, vascular tone and measurement site. Cerebral oxygen saturation was correlated with hemoglobin, etCO2 and pCO2 values, which is consistent with the literature. No statistical correlation was found between PVI and NIRS

Keywords: Near-infrared spectroscopy; pleth variability index; major abdominal surgery

Anahtar Kelimeler

Near-infrared spectroscopy, pleth variability index, major abdominal surgery

Peroperatif Sıvı Dengesinin PVI (Pleth Variability Index) ile Değerlendirilmesi ve NIRS (Near Infrared Spectroscopy) ile Korelasyonu

Öz

Amaç: Bu çalışmada; majör abdominal cerrahilerde verilen sıvı tedavisinin PVI (pleth variability indeks) ile değerlendirilmesi ve NIRS (serebral oksimetre) ile korelasyonunun izlenmesi amaçlandı.

Gereç ve yöntemler: Prospektif, gözlemsel olarak tasarlanan bu çalışmaya, majör abdominal cerrahi geçirecek ASA fiziksel durum skoru I-II-III olan 86 hasta dahil edildi. Tüm olgulara anestezi öncesi standart ASA monitörizasyonuna ek olarak serebral oksimetri (yakın-kızıl ötesi spektroskopi ile sağ-sol serebral oksijen satürasyonu) ve PVI (pleth variability indeks) monitörizasyonu yapıldı. Arteriyel kanülasyon yapılmış olan hastalar çalışmaya dahil edildi. Hastaların demografik ve hemodinamik verileri, sağ/sol serebral oksijen satürasyon değerleri ve PVI değerleri indüksiyon öncesi bazal, indüksiyon sonrası 5. dakika , 1., 2.,3.,4., 5. saat ve cerrahi bitiminde kayıt altına alındı.

Bulgular: Çalışmamızda sağ ve sol serebral oksijen satürasyonun hemoglobin, etCO2 ve pCO2 ile korele olduğu saptandı. Benzer korelasyonun etCO2 ve PVI arasında da olduğu Ancak PVI değerinin hemoglobin ile korelasyonunun olmadığı saptandı. PVI’nin sistolik arterial basınç ve bazal sağ serebral oksijen satürasyonu ile korelasyonu saptandı.

Sonuç: Majör abdominal cerrahilerde, sıvı tedavisinin PVI ile değerlendirilmesinin hipotermi, vasküler tonus, ölçüm yeri gibi faktörlerden etkilendiği sonucuna vardık. Serebral oksijen satürasyonu literatürle uyumlu olacak şekilde, hemoglobin, etCO2 ve pCO2 değerleri ile korelasyon göstermiştir. PVI ile NIRS arasında da istatistiksel bir korelasyon saptanmamıştır.

Anahtar kelimeler: Yakın-kızıl ötesi spektroskopi; majör abdominal cerrahi; Dalga değişkenlik indeksi

Anahtar Kelimeler

Yakın-kızılötesi spektroskopi, majör abdominal cerrahi, dalga değişkenlik indeksi

Kaynakça

• 1. Wakeling HG, McFall MR, Jenkins CS, Woods WGA, Miles WFA, Barclay GR, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth. 2005;95:634-42.
• 2. Warnakulasuriya SR, Davies SJ, Wilson RJT, Yates DRA. Comparison of esophageal Doppler and plethysmographic variability index to guide intraoperative fluid therapy for low-risk patients undergoing colorectal surgery. J Clin Anesth. 2016:34:600-8.
• 3. Yu Y, Dong J, Xu Z, Shen H, Zheng J. Pleth variability index-directed fluid management in abdominal surgery under combined general and epidural anesthesia. J Clin Monit Comput. 2015;29:47-52.
• 4. Zimmermann M, Feibicke T, Keyl C, Prasser C, Moritz S, Bernhard MG, et al. Accuracy of stroke volume variation compared with pleth variability index to predict fluid responsiveness in mechanically ventilated patients undergoing major surgery. Eur J Anaesthesiol. 2010;27:555-61.
• 5. Sondergaard S, Parkin G, Aneman A. Central venous pressure: We need to bring clinical use into physiological context. Acta Anaesthesiol Scand. 2015;59:552-60.
• 6. Gelman S. Venous function and central venous pressure: A physiologic story. Anesthesiology. 2008;108:735-48.
• 7. Chu H, Wang Y, Sun Y, Wang G. Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis. J Clin Monit Comput. 2016;30:265-74.
• 8. Forget P, Lois F, De Kock M. Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management. Anesth Analg. 2010;111:910-4.
• 9. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103 Suppl 1:i3-13.
• 10.Thacker JKM, Mountford WK, Ernst FR, Krukas MR, Mythen MG. Perioperative fluid utilization variability and association with outcomes. Ann Surg. 2016;263:502-10.
• 11.Shin CH, Long DR, McLean D, Grabitz SD, Ladha K, Timm FP, et al. Effects of ıntraoperative fluid management on postoperative outcomes: A hospital registry study. Ann Surg. 2018;267:1084-92.
• 12.Mousa WF. Effect of hypercapnia on pleth variability index during stable propofol: Remifentanil anesthesia. Saudi J Anaesth. 2013;7:234-7.
• 13.Greene NH, Lee LA. Modern and evolving understanding of cerebral perfusion and autoregulation. Adv Anesth. 2012;30:97-129.
• 14.Kim SY, Chae DW, Chun YM, Jeong KH, Park K, Han DW. Modelling of the effect of end-tidal carbon dioxide on cerebral oxygen saturation in beach chair position under general anaesthesia. Basic Clin Pharmacol Toxicol. 2016;119:85-92.
• 15.Arieff AI. Fatal postoperative pulmonary edema: Pathogenesis and literature review. Chest. 1999;115:1371-7.
• 16.Moller AM, Pedersen T, Svendsen PE, Engquist A. Perioperative risk factors in elective pneumonectomy: The impact of excess fluid balance. Eur J Anaesthesiol. 2002;19:57-62.
• 17.Joshi GP. Intraoperative fluid restriction improves outcome after major elective gastrointestinal surgery. Anesth Analg. 2005;101:601-05.
• 18.Eyeington CT, Ancona P, Osawa EA, Cutuli SL, Eastwood GM, Bellomo R. Modern technology–derived normative values for cerebral tissue oxygen saturation in adults. Anaesth Intensive Care. 2019;47:69-75.
• 19.Vretzakis G, Georgopoulou S, Stamoulis K, Stamatiou G, Tsakiridis K, Zarogoulidis P, et al. Cerebral oximetry in cardiac anesthesia. J Thorac Dis. 2014;6 Suppl 1:S60-9.
• 20.Lassnigg A, Hiesmayr M, Keznickl P, Müllner T, Ehrlich M, Grubhofer G. Cerebral oxygenation during cardiopulmonary bypass measured by near- infrared spectroscopy: Effects of hemodilution, temperature, and flow. J Cardiothorac Vasc Anesth. 1999;13:544-8.
• 21.Soller BR, Yang Y, Soyemi OO, Ryan KL, Rickards CA, Walz JM, et al. Noninvasively determined muscle oxygen saturation is an early indicator of central hypovolemia in humans. J Appl Physiol. 2008;104:475-81. 123
• 22.Sabuncu Ü, Özgök A. Serebral oksijen satürasyonu monitörizasyonunun rejyonel doku hipoksisini tespit etmedeki yeri. GKDA Derg. 2016;22:125-27.
• 23.Sandroni C, Cavallaro F, Marano C, Falcone C, De Santis P, Antonelli M. Accuracy of plethysmographic indices as predictors of fluid responsiveness in mechanically ventilated adults: A systematic review and meta-analysis. Intensive Care Med. 2012;38:1429-37.
• 24.Lopes MR, Oliveira MA, Pereira VOS, Lemos IPB, Auler JOC, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: A pilot randomized controlled trial. Crit Care. 2007;11:R100.
• 25.Cannesson M, Desebbe O, Rosamel P, Delannoy B, Robin J, Bastien O, et al. 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;101:200-6.
• 26.Piskin O, Oz II. Accuracy of pleth variability index compared with inferior vena cava diameter to predict fluid responsiveness in mechanically ventilated patients. Medicine (Baltimore). 2017;96:e8889.
• 27.Prabhu SP, Nileshwar A, Krishna HM. Stroke volume variation and pleth variability ındex. Are they two faces of the same coin? Journal of Clinical and Diagnostic Research. 2019;13:1-5.
• 28.Broch O, Bein B, Gruenewald M, Höcker J, Schöttler J, Meybohm P, et al. Accuracy of the pleth variability index to predict fluid responsiveness depends on the perfusion index. Acta Anaesthesiol Scand. 2011;55:686-93.
• 29.Solus-Biguenet H, Fleyfel M, Tavernier B, Kipnis E, Onimus J, Robin E, et al. Non-invasive prediction of fluid responsiveness during major hepatic surgery. Br J Anaesth. 2006;97:808-16.
• 30.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;30:1210-3.
• 31.Biais M, Cottenceau V, Petit L, Masson F, Cochard JF, Sztark F. Impact of norepinephrine on the relationship between pleth variability index and pulse pressure variations in ICU adult patients. Crit Care. 2011;15:R168.
• 32.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;103:372-7.