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Pulse oximetry wave variation as a noninvasive tool to assess volume status in cardiac surgery
Westphal, Glauco A; Silva, Eliezer; Gonçalves, Anderson Roman; Caldeira Filho, Milton; Poli-de-Figueiredo, Luíz F.
  • Westphal, Glauco A; Centro Hospitalar Unimed Joinville. Intensive Care Unit. Joinville. BR
  • Silva, Eliezer; Hospital Israelita Albert Einstein. Intensive Care Unit. São Paulo. BR
  • Gonçalves, Anderson Roman; Centro Hospitalar Unimed Joinville. Intensive Care Unit. Joinville. BR
  • Caldeira Filho, Milton; Centro Hospitalar Unimed Joinville. Intensive Care Unit. Joinville. BR
  • Poli-de-Figueiredo, Luíz F; Universidade de São Paulo. Faculdade de Medicina. Department of Surgery. LIM 26. São Paulo. BR
Clinics ; 64(4): 337-343, 2009. graf, tab
Article Dans Anglais | LILACS | ID: lil-511936
ABSTRACT

OBJECTIVE:

To compare variations of plethysmographic wave amplitude (ÃPpleth) and to determine the percent difference between inspiratory and expiratory pulse pressure (ÃPp) 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. ÃPp, systolic pressure (ÃPs), DPpleth, and systolic component (ÃSpleth) were calculated. A DPp > 13 percent 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, ÃPp 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 percent (AUC = 0.95±0.04), (Ps of 8 percent (AUC=0.93±0.05), and (Spleth of 32 percent (AUC=0.82±0.07). A (Ppleth value > 11 percent predicted (Pp > 13 percent with 100 percent specificity and 91 percent sensitivity. Volume expansion, performed in 20 patients, changed (Pp, (Ppleth, (Ps and (Spleth significantly (p<0.008).

CONCLUSIONS:

ÃPpleth is well correlated with DPp and constitutes a simple and non-invasive method for assessing fluid responsiveness in patients following cardiac surgery.
Sujets)

Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Débit systolique / Pression sanguine / Oxymétrie / Procédures de chirurgie cardiaque Type d'étude: Étude observationnelle / Étude pronostique / Facteurs de risque Limites du sujet: Femelle / Humains / Mâle langue: Anglais Texte intégral: Clinics Thème du journal: Médicament Année: 2009 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Centro Hospitalar Unimed Joinville/BR / Hospital Israelita Albert Einstein/BR / Universidade de São Paulo/BR

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Texte intégral: Disponible Indice: LILAS (Amériques) Sujet Principal: Débit systolique / Pression sanguine / Oxymétrie / Procédures de chirurgie cardiaque Type d'étude: Étude observationnelle / Étude pronostique / Facteurs de risque Limites du sujet: Femelle / Humains / Mâle langue: Anglais Texte intégral: Clinics Thème du journal: Médicament Année: 2009 Type: Article Pays d'affiliation: Brésil Institution/Pays d'affiliation: Centro Hospitalar Unimed Joinville/BR / Hospital Israelita Albert Einstein/BR / Universidade de São Paulo/BR