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Respiratory variations in pulse oximeter waveform amplitude are influenced by venous return in mechanically ventilated patients under general anaesthesia

Published online by Cambridge University Press:  01 March 2007

M. Cannesson ,
O. Desebbe ,
M. Hachemi ,
D. Jacques ,
O. Bastien  and
J.-J Lehot
M. Cannesson
Affiliation:
Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France
O. Desebbe
Affiliation:
Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France
M. Hachemi
Affiliation:
Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France
D. Jacques
Affiliation:
Lyon Sud Hospital, Intensive Care Unit, Hospices Civils de Lyon, Lyon, France
O. Bastien
Affiliation:
Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France
J.-J Lehot
Affiliation:
Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France
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Summary

Background and objectives

Respiratory variations in pulse oximetry plethysmographic waveform amplitude (ΔPOP) are related to respiratory variations in arterial pulse pressure (ΔPP) in the critical care setting. The aims of this study were to test the hypothesis that in mechanically ventilated patients undergoing general anaesthesia, ΔPOP calculation is feasible and can detect changes in preload.

Methods

Twenty-five mechanically ventilated patients were studied immediately after induction of general anaesthesia. Haemodynamic data (mean arterial pressure [MAP], central venous pressure [CVP], ΔPP and ΔPOP) were recorded at baseline, before and after tilting the patient from anti-Trendelenburg to Trendelenburg position in order to induce preload changes.

Results

Change from anti-Trendelenburg to Trendelenburg position induced changes in MAP (58 ± 9 to 67 ± 10 mmHg, P < 0.05), CVP (4 ± 4 to 13 ± 5 mmHg, P < 0.05), ΔPP (14 ± 8 to 7 ± 5%, P < 0.05) and ΔPOP (17 ± 12 to 9 ± 5%, P < 0.05). There was a significant relationship between ΔPOP in anti-Trendelenburg position and percent change in MAP after volume expansion (r = 0.82; P < 0.05).

Conclusions

ΔPOP can be determined in the operating room and is influenced by changes in preload. This new index has potential clinical applications for the prediction of fluid responsiveness.

Keywords

ANAESTHESIA GENERALARTIFICIAL VENTILATIONCARDIOVASCULAR PHYSIOLOGY, plethysmography, oximetryCENTRAL VENOUS PRESSUREHYPVOLAEMIAMONITORING PHYSIOLOGICPOSTURE, head-down tilt
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 245 - 251
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Michard, F, Boussat, S, Chemla, D et al. . Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 2000; 162: 134–138.CrossRefGoogle ScholarPubMed
2.Feissel, M, Michard, F, Mangin, I et al. . Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest 2001; 119: 867–873.CrossRefGoogle ScholarPubMed
3.Tavernier, B, Makhotine, O, Lebuffe, G, Dupont, J, Scherpereel, P. Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 1998; 89: 1313–1321.CrossRefGoogle ScholarPubMed
4.Rex, S, Brose, S, Metzelder, S et al. . Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 2004; 93: 782–788.CrossRefGoogle ScholarPubMed
5.Wiesenack, C, Fiegl, C, Keyser, A, Prasser, C, Keyl, C. Assessment of fluid responsiveness in mechanically ventilated cardiac surgical patients. Eur J Anaesthesiol 2005; 22: 658–665.CrossRefGoogle ScholarPubMed
6.Michard, F. Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005; 103: 419–428 [quiz 449–415].CrossRefGoogle ScholarPubMed
7.Bendjelid, K, Romand, JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 2003; 29: 352–360.CrossRefGoogle ScholarPubMed
8.Pinsky, MR, Teboul, JL. Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care 2005; 11: 235–239.CrossRefGoogle ScholarPubMed
9.Feissel, M, Badie, J, Merlani, PG, Faller, JP, Bendjelid, K. Pre-ejection period variations predict the fluid responsiveness of septic ventilated patients. Crit Care Med 2005; 33: 2534–2539.CrossRefGoogle ScholarPubMed
10.Feissel, M, Michard, F, Faller, JP, Teboul, JL. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med 2004; 30: 1834–1837.CrossRefGoogle ScholarPubMed
11.Reuter, DA, Felbinger, TW, Schmidt, C et al. . Stroke volume variation for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 2002; 28: 392–398.CrossRefGoogle ScholarPubMed
12.Bedford, RF, Wollman, H. Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology 1973; 38: 228–236.CrossRefGoogle ScholarPubMed
13.Jones, RM, Hill, AB, Nahrwold, ML, Bolles, RE. The effect of method of radial artery cannulation on postcannulation blood flow and thrombus formation. Anesthesiology 1981; 55: 76–78.CrossRefGoogle ScholarPubMed
14.Slama, M, Masson, H, Teboul, JL et al. . Monitoring of respiratory variations of aortic blood flow velocity using oesophageal Doppler. Intensive Care Med 2004; 30: 1182–1187.CrossRefGoogle Scholar
15.Cannesson, M, Besnard, C, Durand, PG, Bohe, J, Jacques, D. Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients. Crit Care 2005; 9: R562–R568.CrossRefGoogle ScholarPubMed
16.Monnet, X, Lamia, B, Teboul, JL. Pulse oximeter as a sensor of fluid responsiveness: do we have our finger on the best solution? Crit Care 2005; 9: 429–430.CrossRefGoogle ScholarPubMed
17.Buhre, W, Weyland, A, Buhre, K et al. . Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth 2000; 84: 354–357.CrossRefGoogle ScholarPubMed
18.Bland, JM, Altman, DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–310.Google ScholarPubMed
19.Cahalan, MK, Abel, M, Goldman, M et al. . American Society of Echocardiography and Society of Cardiovascular Anesthesiologists Task Force guidelines for training in perioperative echocardiography. Anesth Analg 2002; 94: 1384–1388.CrossRefGoogle ScholarPubMed
20.Dorlas, JC, Nijboer, JA. Photo-electric plethysmography as a monitoring device in anaesthesia. Application and interpretation. Br J Anaesth 1985; 57: 524–530.CrossRefGoogle ScholarPubMed
21.Shamir, M, Eidelman, LA, Floman, Y, Kaplan, L, Pizov, R. Pulse oximetry plethysmographic waveform during changes in blood volume. Br J Anaesth 1999; 82: 178–181.CrossRefGoogle ScholarPubMed
22.Partridge, BL. Use of pulse oximetry as a noninvasive indicator of intravascular volume status. J Clin Monit 1987; 3: 263–268.CrossRefGoogle ScholarPubMed