Pulse oximetry wave variation as a noninvasive tool to assess volume status in cardiac surgery.
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.


BACKGROUND
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.
Westphal
Glauco A
GA
Intensive Care Unit, Centro Hospitalar Unimed Joinville, Joinville, SC, Brazil.
Silva
Eliezer
E
Gonçalves
Anderson Roman
AR
Caldeira Filho
Milton
M
Poli-de-Figueiredo
Luíz F
LF
D001794:Blood Pressure / Q000502:physiology*; D006348:Cardiac Surgical Procedures; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods*; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome