Pulse Oximetry Wave Variation As a Noninvasive Tool to Assess Volume Status in Cardiac Surgery

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2009 Jun 3

PMID 19488592

Citations 10

Authors

Glauco A Westphal

Eliezer Silva

Anderson Roman Goncalves

Milton Caldeira Filho

Luiz F Poli-de-Figueiredo

Affiliations

Soon will be listed here.

Abstract

Objective: To compare variations of plethysmographic wave amplitude (DeltaPpleth) and to determine the percent difference between inspiratory and expiratory pulse pressure (DeltaPp) cutoff values for volume responsiveness in a homogenous population of postoperative cardiac surgery patients.

Introduction: Intra-thoracic pressure variations interfere with stroke volume variation. Pulse pressure variations through arterial lines during mechanical ventilation have been recommended for the estimation of fluid responsiveness. Pulse oximetry may offer a non-invasive plethysmographic method to evaluate pulse pressure; this may be useful for guiding fluid replacement.

Methods: Controlled, prospective study in cardiac surgery patients under controlled ventilation. Simultaneous digital recordings of arterial pressure and plethysmographic waves were performed. DeltaPp, systolic pressure (DeltaPs), DPpleth, and systolic component (DeltaSpleth) were calculated. A DPp > or = 13% identified fluid-responsive patients. Volume expansion was performed in responsive subjects. Systolic and amplitude components of pressure and plethysmographic waves were compared.

Results: In 50 measurements from 43 patients, DeltaPp was correlated with (Ppleth (r=0.90, p<0.001), (Ps (r=0.90, p<0.001), and (Spleth (r=0.73, p<0.001). An aArea under ROC curve (AUC) identified the fluid responsiveness thresholds: (Ppleth of 11% (AUC = 0.95+/-0.04), (Ps of 8% (AUC=0.93+/-0.05), and (Spleth of 32% (AUC=0.82+/-0.07). A (Ppleth value > or = 11% predicted (Pp > or = 13% with 100% specificity and 91% sensitivity. Volume expansion, performed in 20 patients, changed (Pp, (Ppleth, (Ps and (Spleth significantly (p<0.008).

Conclusions: DeltaPpleth is well correlated with DPp and constitutes a simple and non-invasive method for assessing fluid responsiveness in patients following cardiac surgery.

Citing Articles

Can the behavior of blood pressure after elevation of the positive end-expiratory pressure help to determine the fluid responsiveness status in patients with septic shock?.

Cherem S, Fernandes V, Zambonato K, Westphal G Rev Bras Ter Intensiva. 2020; 32(3):374-380.

PMID: 33053026 PMC: 7595715. DOI: 10.5935/0103-507X.20200065.

Accuracy of pulse oximetry in detection of oxygen saturation in patients admitted to the intensive care unit of heart surgery: comparison of finger, toe, forehead and earlobe probes.

Seifi S, Khatony A, Moradi G, Abdi A, Najafi F BMC Nurs. 2018; 17:15.

PMID: 29692684 PMC: 5905124. DOI: 10.1186/s12912-018-0283-1.

Respiratory modulations in the photoplethysmogram (DPOP) as a measure of respiratory effort.

Addison P J Clin Monit Comput. 2015; 30(5):595-602.

PMID: 26377021 PMC: 5023749. DOI: 10.1007/s10877-015-9763-y.

On better estimating and normalizing the relationship between clinical parameters: comparing respiratory modulations in the photoplethysmogram and blood pressure signal (DPOP versus PPV).

Addison P, Wang R, Uribe A, Bergese S Comput Math Methods Med. 2015; 2015:576340.

PMID: 25691912 PMC: 4322304. DOI: 10.1155/2015/576340.

Increasing signal processing sophistication in the calculation of the respiratory modulation of the photoplethysmogram (DPOP).

Addison P, Wang R, Uribe A, Bergese S J Clin Monit Comput. 2014; 29(3):363-72.

PMID: 25209132 PMC: 4420848. DOI: 10.1007/s10877-014-9613-3.

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