Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Comparison of Pleth Variability Index and Inferior Vena Cava Distensibility as a Perfusion Indicator in Sepsis Patients: An Observational Study
Sepsis Hastalarında Perfüzyon Belirteci Olarak Pleth Değişkenlik İndeksi ve Vena Kava İnferior Gerilebilirliğinin Karşılaştırılması: Gözlemsel Çalışma
Orhan GÖKTÜRKa, Onur AVCIb, Oğuz GÜNDOĞDUc, Ahmet Cemil İSBİRb, İclal ÖZDEMİR KOLb, Sinan GÜRSOYb, Kenan KAYGUSUZb
aClinic of Anaesthesiology and Reanimation, Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
bDepartment of Anaesthesiology and Reanimation, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Türkiye
cClinic of Anaesthesiology and Reanimation, Sivas Numune Hospital, Sivas, Türkiye
Turkiye Klinikleri J Med Sci. 2022;42(2):79-86
doi: 10.5336/medsci.2021-85651
Article Language: EN
Full Text
ABSTRACT
 Objective: The aim of this study was to compare the sensitivity and specificity of Pleth Variability Index (PVI) and distensibility of inferior vena cava (dIVC) in fluid responsiveness of patients with sepsis. Material and Methods: Forty patients over 18 years of age who underwent fluid replacement for sepsis in the intensive care unit were included in the study. In our study, the patients were divided into 2 groups as those who had less than 15% increase in cardiac output (CO), and those who had more than 15% increase in CO after fluid replacement (fluid responders and non-responders). Before fluid replacement, demographic data of the patients (age, weight, cause of sepsis, body surface area, SOFA score), vital parameters (systolic arterial pressure, diastolic arterial pressure, mean arterial pressue, heart rate) and measuredd values (maximum diameter of vena cava inferior, minimum diameter of vena cava inferior, central venous pressure, PVI, CO, and stroke volume) were recorded. After applying crystalloid in a dose of 10 mL/kg for 15 minutes, the recorded parameters were repeated at 15th minute. Results: When receiver operating characteristic (ROC) analysis was performed for dIVC, the area under the curve (AUC) was found to be 0.833 (0.739-0.926). The threshold value was found to be 17.52%, sensitivity was 77.5%, and specificity was 72.5%. When ROC analysis was performed for PVI, AUC was found to be 0.889 (0.817-0.962). The threshold value was found as 12.50%, sensitivity was 72.5%, and specificity was 92.5%. Conclusion: PVI was found to be more specific but less sensitive than dIVC. dIVC is less sensitive and less specific than central venous pressure. However, dIVC and PVI can give useful results in patients who have contraindication of an invasive technique.

Keywords: Sepsis; sıvı tedavisi; kardiyak output
ÖZET
 Amaç: Bu çalışmanın amacı Pleth Değişkenlik İndeksi (PVI) ve inferior vena kava distensibilitesinin (dIVC) sepsisli hastalarda sıvı yanıtını değerlendirmedeki duyarlılığını ve özgüllüğünü karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya, yoğun bakım ünitesindeki sepsis tanısı almış sıvı replasmanı uygulanacak 18 yaş üstü bireylerden 40 hasta dâhil edildi. Çalışmamızda hastalar, sıvı replasmanı sonrası 'kardiyak output'ta [cardiac output (CO)] %15'ten az ve %15'ten fazla artış olan (sıvıya cevap verenler ve vermeyenler) olarak 2'ye ayrıldı. Hastaların sıvı replasmanı öncesi demografik verileri (yaş, kilo, sepsis nedeni, vücut yüzey alanı, SOFA skoru), vital parametreleri (sistolik arter basıncı, diaystolik arter basıncı, ortlama arter basıncı, kalp atım hızı) ve ölçüm değerleri (vena cava inferior maksimum çapı, vena cava inferior minimum çapı, santral venöz basınç, PVI, CO, vuruş hacmi) kayıt edildi. Hastalara 15 dk boyunca 10 mL/kg kristaloid uygulandıktan sonra kayıt edilen parametreler tekrarlandı. Bulgular: dIVC için alıcı işletim karakteristiği [receiver operating characteristic (ROC)] analizi yapıldığında, eğri altında kalan alan [area under the curve (AUC)] 0,833 (0,739-0,926) bulunmuştur. Eşik değer %17,52 bulunmuş olup; duyarlılık %77,5, özgüllük %72,5 bulunmuştur. PVI için ROC analizi yapıldığında, AUC 0,889 (0,817-0,962) bulunmuştur. Eşik değer %12,50 bulunmuş olup; duyarlılık %72,5, özgüllük %92,5 bulunmuştur. Sonuç: PVI'nın, dIVC'den daha spesifik ancak daha az duyarlı olduğu bulundu. dIVC, santral venöz basınçtan daha az duyarlı ve daha az spesifik bulundu. Bununla birlikte dIVC ve PVI, invaziv bir teknik için kontrendikasyonu olan hastalarda faydalı sonuçlar verebilir.

Anahtar Kelimeler: Sepsis; fluid therapy; cardiac output
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