Noninvasive monitoring: fluid responsiveness using the pleth variability index & continuous hemoglobin — insights from UCI CMO Dr. William Wilson

During a Nov. 5 webinar hosted by Becker's Healthcare Review and sponsored by Masimo, UC Irvine Health System's CMO discussed an innovative, noninvasive care approach for critically ill patients.

The speaker was: 

  • William Wilson, MD, MA, CMO and clinical professor at UCI Health System

Four presentation takeaways:

1. Fluid administration is one of the most common interventions made in the operating room and intensive care unit, Dr. Wilson began. There are a few ways to identify fluid responsiveness, including stroke volume variation (SVV), pulse pressure variation (PPV) and pleth variability index (PVi). While PPV and SVV use the arterial pressure waveform, PVi uses the arterial pleth waveform noninvasively detected from a pulse oximetry sensor to automatically calculate the dynamic changes that occur during the respiratory cycle. In August 2020, Masimo's PVi received FDA clearance as an indicator of fluid responsiveness on mechanically ventilated patients.  

2. Noninvasive and continuous hemoglobin (SpHb) provides real-time visibility to changes, or lack thereof, in hemoglobin between invasive blood samples. Masimo's rainbow pulse CO-oximetry sensors employ multiple wavelengths of light to measure blood characteristics based on light absorption to offer SpHb noninvasively and continuously.

3. Combining SpHb and PVi creates integrated goal-directed therapy, Dr. Wilson said. The use of both PVi and SpHb led to earlier transfusion, but with fewer units of blood transfused, according to a 2019 study in The Journal of Clinical Monitoring and Computing. Researchers recorded a 33 percent lower mortality rate 30 days after surgery and a 29 percent lower mortality rate 90 days after surgery using the integrated goal-directed therapy approach.

4. In conclusion, dynamic measures of volume responsiveness should be used to guide fluid administration. PVi has the advantage of being noninvasive and widely available, while continuous hemoglobin monitoring provides real-time values. An integrated approach of both can result in fewer units of blood transfused and improved outcomes, including survival rate, said Dr. Wilson.

Click here for more information about Masimo. Click here to view the full webinar.

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