J Clin Monit Comput - Impact of skin incision on the pleth variability index.

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Resumo

JECTIVE: The pleth variability index (PVI), which is calculated from respiratory variations in the perfusion index (PI), reportedly predicts fluid responsiveness. However, vasomotor tone fluctuations induced by nociceptive stimuli change the PI and may reduce the accuracy of PVI. The aim of this study was to confirm the effects of surgical stimuli on PVI.METHODS: Twenty-four patients were examined after the induction of general anesthesia. Heart rate (HR), mean arterial blood pressure (MBP), PI, PVI, stroke volume variation (SVV), and cardiac index (CI) were recorded before and after the skin incision. PI and PVI were calculated using a Radical 7 pulse oximeter, and SVV and CI were calculated using the FloTrac/Vigileo system.RESULTS: After the skin incision, the PI decreased significantly from 5.3 (4.0-6.2%) to 3.6% (1.8-4.7%), whereas the PVI increased significantly from 9.5 (7.0-12.0%) to 13.5% (9.0-16.0%). A significant negative correlation was observed between the changes in PI and PVI before and after the skin incision. The skin incision did not affect the HR, CI, or SVV but increased the MBP.CONCLUSION: This study showed a significant increase in the PVI and a negative correlation between the changes in PVI and PI before and after the skin incision. The PVI can be calculated from the variations in the PI caused not by mechanical ventilation, but rather by fluctuations in vasomotor tone. When using the PVI as an indicator for fluid responsiveness, it is crucial to pay attention to fluctuations in vasomotor tone induced by nociceptive stimuli.

Resumo Limpo

jectiv pleth variabl index pvi calcul respiratori variat perfus index pi report predict fluid respons howev vasomotor tone fluctuat induc nocicept stimuli chang pi may reduc accuraci pvi aim studi confirm effect surgic stimuli pvimethod twentyfour patient examin induct general anesthesia heart rate hr mean arteri blood pressur mbp pi pvi stroke volum variat svv cardiac index ci record skin incis pi pvi calcul use radic puls oximet svv ci calcul use flotracvigileo systemresult skin incis pi decreas signific wherea pvi increas signific signific negat correl observ chang pi pvi skin incis skin incis affect hr ci svv increas mbpconclus studi show signific increas pvi negat correl chang pvi pi skin incis pvi can calcul variat pi caus mechan ventil rather fluctuat vasomotor tone use pvi indic fluid respons crucial pay attent fluctuat vasomotor tone induc nocicept stimuli

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