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. 2024 Sep 16;28(1):305.
doi: 10.1186/s13054-024-05085-w.

Testing preload responsiveness by the tidal volume challenge assessed by the photoplethysmographic perfusion index

Chiara Bruscagnin  1   2 , Rui Shi  1 , Daniela Rosalba  1 , Gaelle Fouqué  1 , Julien Hagry  1 , Christopher Lai  1 , Katia Donadello  2 , Tài Pham  1   3 , Jean-Louis Teboul  1 , Xavier Monnet  4
Affiliations

Testing preload responsiveness by the tidal volume challenge assessed by the photoplethysmographic perfusion index

Chiara Bruscagnin et al. Crit Care. .

Abstract

Background: To detect preload responsiveness in patients ventilated with a tidal volume (Vt) at 6 mL/kg of predicted body weight (PBW), the Vt-challenge consists in increasing Vt from 6 to 8 mL/kg PBW and measuring the increase in pulse pressure variation (PPV). However, this requires an arterial catheter. The perfusion index (PI), which reflects the amplitude of the photoplethysmographic signal, may reflect stroke volume and its respiratory variation (pleth variability index, PVI) may estimate PPV. We assessed whether Vt-challenge-induced changes in PI or PVI could be as reliable as changes in PPV for detecting preload responsiveness defined by a PLR-induced increase in cardiac index (CI) ≥ 10%.

Methods: In critically ill patients ventilated with Vt = 6 mL/kg PBW and no spontaneous breathing, haemodynamic (PICCO2 system) and photoplethysmographic (Masimo-SET technique, sensor placed on the finger or the forehead) data were recorded during a Vt-challenge and a PLR test.

Results: Among 63 screened patients, 21 (33%) were excluded because of an unstable PI signal and/or atrial fibrillation and 42 were included. During the Vt-challenge in the 16 preload responders, CI decreased by 4.8 ± 2.8% (percent change), PPV increased by 4.4 ± 1.9% (absolute change), PIfinger decreased by 14.5 ± 10.7% (percent change), PVIfinger increased by 1.9 ± 2.6% (absolute change), PIforehead decreased by 18.7 ± 10.9 (percent change) and PVIforehead increased by 1.0 ± 2.5 (absolute change). All these changes were larger than in preload non-responders. The area under the ROC curve (AUROC) for detecting preload responsiveness was 0.97 ± 0.02 for the Vt-challenge-induced changes in CI (percent change), 0.95 ± 0.04 for the Vt-challenge-induced changes in PPV (absolute change), 0.98 ± 0.02 for Vt-challenge-induced changes in PIforehead (percent change) and 0.85 ± 0.05 for Vt-challenge-induced changes in PIfinger (percent change) (p = 0.04 vs. PIforehead). The AUROC for the Vt-challenge-induced changes in PVIforehead and PVIfinger was significantly larger than 0.50, but smaller than the AUROC for the Vt-challenge-induced changes in PPV.

Conclusions: In patients under mechanical ventilation with no spontaneous breathing and/or atrial fibrillation, changes in PI detected during Vt-challenge reliably detected preload responsiveness. The reliability was better when PI was measured on the forehead than on the fingertip. Changes in PVI during the Vt-challenge also detected preload responsiveness, but with lower accuracy.

Keywords: Catecholamine; Fluid accumulation; Fluids; Systemic venous return; Vasodilatation.

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Conflict of interest statement

X.M. is a member of the Medical Advisory Board of Pulsion Medical Systems (Getinge) and received honoraria for lectures from Pulsion Medical Systems (Getinge), Baxter and AOP health. J-L.T. is a member of the Medical Advisory Board of Pulsion Medical Systems (Getinge). The other authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Receiver operating characteristics curves describing the ability to detect preload responsiveness of the tidal-volume-challenge-induced changes in pulse pressure variation (PPV, change in absolute value), in the pleth variability index measured on the forehead (PVI, change in absolute value) and in the perfusion index measured on the forehead (PI, change in percent)
See this image and copyright information in PMC

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