The comparison of the effectiveness of finger and forehead plethysmographic variability index monitoring in pediatric patients

The Comparison of the Effectiveness of Finger and Forehead Plethysmographic Variability Index Monitoring in Pediatric Patients Introduction: The Plethysmographic Variability Index (PVI) can be measured with both finger and forehead probes. Vasoconstriction may reduce the reliability of PVI measurements in pediatric surgical patients prone to hypothermia (1). The vascular structure of the forehead area is resistant to changes in vasomotor tonus (2,3). The aim of our study is to compare the efficacy of PVI values ​​measured at the finger and forehead areas to predict fluid responsiveness in these patients. Material and Method: Fifty pediatric patients with obtained parental consent and ethics committee approval underwent elective minor surgery were included into the study. Basic monitoring, finger and forehead perfusion index (PI) and PVI monitoring were applied. Hemodynamic parameters, PI, PVI, cardiac output (CO) values ​​were recorded. The 15% increase in CO with passive leg raise (PLR) maneuver was estimated as fluid responsiveness. Two groups were created: Group R (fluid responsive); Group NR (fluid nonresponsive). Mann-Whitney U, t, chi-square and ROC tests were used in statistical evaluation. Results: Areas under the receiver-operating curves were 0.699 (p = 0.011) and 0.847 (p <0.001) for the finger and forehead PVI respectively, before PLR maneuver. At the threshold value of ≤14%, the sensitivities were 92.9% and 96.4% while the specificities were 45.4% and 72.7% respectively. Conclusion: In pediatric surgical patients, the sensitivity of forehead and finger PVI monitoring was similar for the prediction of fluid responsiveness, whereas the specificity of forehead monitoring was higher. The use of forehead PVI probes in the fluid management of these patients seemed to be appropriate because cephalic region was not affected by low perfusion states. Keywords: PVI, PI, USCOM, Pediatric, Fluid responsivene