Potential value of pleth variability index in intraoperative fluid management of geriatric patients
Yıl: 2022 Cilt: 7 Sayı: 1 Sayfa Aralığı: 15 - 20 Metin Dili: İngilizce DOI: 10.25000/acem.1080760 İndeks Tarihi: 29-12-2022
Potential value of pleth variability index in intraoperative fluid management of geriatric patients
Öz: Aim: This study was designed to determine the effects of pleth variability index (PVI) guided monitoring on the optimal intravascular volume replacement during hip and knee arthroplasty in geriatric patients, and whether using PVI could reduce blood transfusion and vasopressor requirements. Methods: One-hundred geriatric patients who underwent elective hip and knee arthroplasty were included, assigned to either PVI group (volume replacement was PVI guided) or to a control group (volume replacement was based on traditional methods). Sealed envelope technique was used for randomization. Perioperative hemodynamic parameters, infusion rate of crystalloids, colloids, blood/blood products, ephedrine hydrochloride requirements and perioperative urine outputs were recorded. Results: Crystalloid infusion rate was higher (9.5 vs. 6.8 ml/kg/h, p<0.001) and ephedrine requirement was lower (2.0% vs. 38.0%, p<0.001) in group PVI. Postoperatively, the percentage of patients with high BUN, creatinine, and lactate levels were higher among controls (p<0.001). PVI group had significantly lower mean heart rate intraoperatively. Conclusions: Our findings suggest that intraoperative fluid replacement guided by PVI monitoring provides hemodynamic stability, preserves normal levels of BUN, creatinine, and lactate, and reduces unnecessary use of vasopressor agents in elderly surgical patients.
Anahtar Kelime: Geriatrik hastaların intraoperatif sıvı yönetiminde pleth değişkenlik indeksinin potansiyel değeri
Öz: Amaç: Bu çalışma, geriyatrik hastalarda kalça ve diz artroplastisi sırasında pleth değişkenlik indeks (PVI) monitörizasyonunun optimal intravasküler volüm replasmanı üzerindeki etkilerini ve PVI kullanımının kan transfüzyonu ve vazopressör gereksinimlerini azaltıp azaltmayacağını belirlemek için tasarlanmıştır. Yöntemler: Elektif kalça ve diz artroplastisi uygulanan 100 geriyatrik hasta, PVI grubuna (volüm replasmanı PVI rehberliğinde yapıldı) veya kontrol grubuna (geleneksel yöntemlere dayalı volüm replasmanı yapıldı) dahil edildi. Randomizasyon kapalı zarf usulu yöntemine göre yapıldı. Perioperatif hemodinamik parametreler, kristaloidlerin, kolloidlerin, kan ve kan ürünlerinin infüzyon miktarı, efedrin hidroklorür gereksinimleri ve perioperatif idrar çıkışları kaydedildi. Bulgular: Kristalloid transfüzyonu grup PVI'da daha yüksekti (9,5'e karşı 6,8 ml/kg/saat, p<0,001) ve efedrin gereksinimi daha düşüktü (%2,0'ye karşı %38,0, p<0,001). Ameliyat sonrası BUN, kreatinin ve laktat düzeyleri yüksek olan hastaların yüzdesi kontroller arasında daha yüksekti (p<0,001). PVI grubu, intraoperatif anlamlı olarak daha düşük ortalama kalp hızına sahipti. Sonuç: Bulgularımız, PVI monitorizasyonu ile intraoperatif sıvı replasmanının hemodinamik stabilite sağladığını, normal BUN, kreatinin ve laktat seviyelerini koruduğunu ve geriyatrik cerrahi hastalarda gereksiz vazopressör ajan kullanımını azalttığını göstermektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11:175-7.
- 2. Lindeman RD. Overview: renal physiology and pathophysiology of aging. Am J Kidney Dis. 1990;16:275-82.
- 3. Tsuchiya M, Yamada T, Asada A. Pleth variability index predicts hypotension during anesthesia induction. Acta Anaesthesiol Scand. 2010;54:596-602.
- 4. Doherty M, Buggy DJ. Intraoperative fluids: how much is too much? Br J Anaesth. 2012;109:69-79.
- 5. Turkish Anaesthesiology and Reanimation Association (TARD). Perioperative goal directed treatment guideline. Turkey: Turkish Anaesthesiology and Reanimation Association (TARD), 2014.
- 6. Le Manach Y, Hofer CK, Lehot JJ, Vallet B, Goarin JP, Tavernier B, et al. Can changes in arterial pressure be used to detect changes in cardiac output during volume expansion in the perioperative period? Anesthesiology. 2012;117:1165-74.
- 7. Ansari BM, Zochios V, Falter F, Klein AA. Physiological controversies and methods used to determine fluid responsiveness: a qualitative systematic review. Anaesthesia. 2016;71:94-105.
- 8. Wajima Z, Shiga T, Imanaga K. Does pneumoperitoneum affect perfusion index and pleth variability index in patients receiving combined epidural and general anesthesia? Biosci Trends. 2018;11:667-74.
- 9. Fischer MO, Pellissier A, Saplacan V, Gerard JL, Hanouz JL, Fellahi JL. Cephalic versus digital plethysmographic variability index measurement: a comparative pilot study in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2014;28:1510-5.
- 10. Cannesson M, Delannoy B, Morand A, Rosamel P, Attof Y, Bastien O, et al. Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms? Anesth Analg. 2008;106:1189-94.
- 11. Shelley KH, Awad AA, Stout RG, Silverman DG. The use of joint time frequency analysis to quantify the effect of ventilation on the pulse oximeter waveform. J Clin Monit Comput. 2006;20:81-7.
- 12. 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;103:1478-84.
- 13. 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.
- 14. Broch O, Bein B, Gruenewald M, Hocker J, Schottler 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.
- 15. 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.
- 16. Marik PE, Cavallazzi R. Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Crit Care Med. 2013;41:1774-81.
- 17. Fischer MO, Lemoine S, Tavernier B, Bouchakour CE, Colas V, Houard M, et al. Individualized Fluid Management Using the Pleth Variability Index: A Randomized Clinical Trial. Anesthesiology. 2020;133:31-40.
- 18. Laks S, Isaak RS, Strassle PD, Hance L, Kolarczyk LM, Kim HJ. Increased Intraoperative Vasopressor Use as Part of an Enhanced Recovery After Surgery Pathway for Pancreatectomy Does Not Increase Risk of Pancreatic Fistula. J Pancreat Cancer. 2018;4:33-40.
- 19. Neerland BE, Krogseth M, Juliebo V, Hylen Ranhoff A, Engedal K, Frihagen F, et al. Perioperative hemodynamics and risk for delirium and new onset dementia in hip fracture patients; A prospective follow-up study. PLoS One. 2017;12:e0180641.
- 20. Meng L, Cannesson M, Alexander BS, Yu Z, Kain ZN, Cerussi AE, et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011;107:209-17.
- 21. Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, 3rd, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009;87:36-45.
- 22. Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO, Jr., 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.
- 23. Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between Intraoperative Hypotension, Defined by Either Reduction from Baseline or Absolute Thresholds, and Acute Kidney and Myocardial Injury after Noncardiac Surgery: A Retrospective Cohort Analysis. Anesthesiology. 2017;126):47-65.
- 24. Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc. 2001;49:1080-5.
- 25. Bahlmann H, Hahn RG, Nilsson L. Pleth variability index or stroke volume optimization during open abdominal surgery: a randomized controlled trial. BMC Anesthesiol. 2018;18:115.
- 26. Wenkui Y, Ning L, Jianfeng G, Weiqin L, Shaoqiu T, Zhihui T, et al. Restricted peri-operative fluid administration adjusted by serum lactate level improved outcome after major elective surgery for gastrointestinal malignancy. Surgery. 2010;147:542-52.
- 27. Valenza F, Aletti G, Fossali T, Chevallard G, Sacconi F, Irace M, et al. Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit Care. 2005;9:588-93.
| APA | Orhon ergün M, zengin u, Bilgili B, UMUROGLU T (2022). Potential value of pleth variability index in intraoperative fluid management of geriatric patients. , 15 - 20. 10.25000/acem.1080760 |
| Chicago | Orhon ergün Meliha,zengin ulgen,Bilgili Beliz,UMUROGLU Tumay Potential value of pleth variability index in intraoperative fluid management of geriatric patients. (2022): 15 - 20. 10.25000/acem.1080760 |
| MLA | Orhon ergün Meliha,zengin ulgen,Bilgili Beliz,UMUROGLU Tumay Potential value of pleth variability index in intraoperative fluid management of geriatric patients. , 2022, ss.15 - 20. 10.25000/acem.1080760 |
| AMA | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T Potential value of pleth variability index in intraoperative fluid management of geriatric patients. . 2022; 15 - 20. 10.25000/acem.1080760 |
| Vancouver | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T Potential value of pleth variability index in intraoperative fluid management of geriatric patients. . 2022; 15 - 20. 10.25000/acem.1080760 |
| IEEE | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T "Potential value of pleth variability index in intraoperative fluid management of geriatric patients." , ss.15 - 20, 2022. 10.25000/acem.1080760 |
| ISNAD | Orhon ergün, Meliha vd. "Potential value of pleth variability index in intraoperative fluid management of geriatric patients". (2022), 15-20. https://doi.org/10.25000/acem.1080760 |
| APA | Orhon ergün M, zengin u, Bilgili B, UMUROGLU T (2022). Potential value of pleth variability index in intraoperative fluid management of geriatric patients. Archives of Clinical and Experimental Medicine, 7(1), 15 - 20. 10.25000/acem.1080760 |
| Chicago | Orhon ergün Meliha,zengin ulgen,Bilgili Beliz,UMUROGLU Tumay Potential value of pleth variability index in intraoperative fluid management of geriatric patients. Archives of Clinical and Experimental Medicine 7, no.1 (2022): 15 - 20. 10.25000/acem.1080760 |
| MLA | Orhon ergün Meliha,zengin ulgen,Bilgili Beliz,UMUROGLU Tumay Potential value of pleth variability index in intraoperative fluid management of geriatric patients. Archives of Clinical and Experimental Medicine, vol.7, no.1, 2022, ss.15 - 20. 10.25000/acem.1080760 |
| AMA | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T Potential value of pleth variability index in intraoperative fluid management of geriatric patients. Archives of Clinical and Experimental Medicine. 2022; 7(1): 15 - 20. 10.25000/acem.1080760 |
| Vancouver | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T Potential value of pleth variability index in intraoperative fluid management of geriatric patients. Archives of Clinical and Experimental Medicine. 2022; 7(1): 15 - 20. 10.25000/acem.1080760 |
| IEEE | Orhon ergün M,zengin u,Bilgili B,UMUROGLU T "Potential value of pleth variability index in intraoperative fluid management of geriatric patients." Archives of Clinical and Experimental Medicine, 7, ss.15 - 20, 2022. 10.25000/acem.1080760 |
| ISNAD | Orhon ergün, Meliha vd. "Potential value of pleth variability index in intraoperative fluid management of geriatric patients". Archives of Clinical and Experimental Medicine 7/1 (2022), 15-20. https://doi.org/10.25000/acem.1080760 |
