| Comparison between conventional pleth variability index (PVI) and Rainbow PVI (RPVI) in non-cardiothoracic surgery: a retrospective study |
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Chahyun Oh, Chan Noh, Sujin Baek, Sun Yeul Lee, Boohwi Hong |
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Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Korea |
Corresponding author:
Boohwi Hong, Tel: 82-42-280-7840, Fax: 82-42-280-7968,
Email: koho0127@ cnuh.co.kr
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Received: 17 April 2025 • Revised: 29 July 2025 • Accepted: 29 July 2025
*Chahyun Oh and Chan Noh contributed equally to this study as co-first authors. |
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| Abstract |
Background
The rainbow pleth variability index (RPVI) is a newly introduced multiwavelength variant of the pleth variability index (PVI). However, the clinical data on RPVI remains limited. This study retrospectively compared PVI and RPVI in non-cardiothoracic surgery patients using pulse pressure variation (PPV) as a reference.
Methods
Adult patients (≥20 years) who underwent non-cardiothoracic surgery under general anesthesia and had concurrent RPVI, PVI, and invasive arterial pressure monitoring were included. Repeated-measures correlation was used to evaluate the association with PPV. Agreement was assessed using nested Bland-Altman analysis, and receiver operating characteristic (ROC) curve analysis was conducted to assess the predictive performance for detecting high PPV (>13%).
Results
A total of 86 cases (195.3 h of data) were analyzed. The RPVI showed a stronger correlation with PPV than with PVI (r = 0.511 vs. r = 0.243). The Bland-Altman analysis revealed narrower limits of agreement for the RPVI, indicating greater precision. RPVI also demonstrated better predictive performance, with an area under the curve of 0.813 (95% CI, 0.804–0.821) compared to 0.663 (95% CI, 0.653–0.674) for PVI (P < 0.001). The optimal thresholds for detecting PPV >13% were 8.5 for RPVI and 13.5 for PVI.
Conclusions
RPVI demonstrated superior performance compared with PVI, showing a stronger correlation and greater precision with respect to PPV, as well as an improved ability to detect states of elevated PPV. While not a direct substitute for PPV, RPVI may serve as a promising non-invasive index for fluid status assessment. |
| Key Words:
Fluid responsiveness; Noninvasive hemodynamic monitoring; Photoplethysmography; Pleth variability index, Pulse pressure variation; Rainbow pleth variability index |
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