Hypotension during gradual blood loss: waveform variables response and absence of tachycardia.
BACKGROUND
Variation in arterial pressure and plethysmographic waveforms has been shown to be predictors of cardiac output response to fluid challenge. The objective of this study was to evaluate the ability of arterial and plethysmographic waveform variables to predict hypotension during blood loss.


METHODS
Patients undergoing autologous haemodilution were studied. After anaesthesia induction, blood was withdrawn in steps of 2% of estimated circulating blood volume (ECBV). Arterial and plethysmographic waveforms were recorded and analysed offline at each step of blood withdrawal.


RESULTS
Thirty-four (29%) out of 118 studied patients tolerated 20% ECBV withdrawal without hypotension. Patients who tolerated 20% ECBV withdrawal were younger than those who did not [mean (sd): 53.8 (11.1) vs 62.7 (10.7); P<0.0001]. Patients with hypertension developed hypotension earlier than healthier patients did. There were no differences at the baseline in arterial and plethysmographic waveform variables between those who did and those who did not tolerate 20% of ECBV withdrawal. All values of variables increased significantly from the baseline after the withdrawal of 4% of ECBV (P<0.005). There were no changes in heart rate (HR), 73 (12) at the baseline and 76 (13) after 20% of ECBV withdrawal (P=0.4).


CONCLUSIONS
Arterial and plethysmographic waveform variables were augmented with increasing blood loss in all patients. Older patients, patients who received anti-hypertensive drugs, or both developed hypotension earlier than others. Baseline values were weak predictors of hypotension during stepwise blood withdrawal. No clinically significant increase in HR was observed, regardless of tolerance of arterial pressure to blood withdrawal.
Department of Anesthesiology, Critical Care and Pain Medicine, Carmel Lady Davis Medical Center, 7 Michal Street, Haifa 34362, Israel. pizov_reuven@clalit.org.il
R
R
Pizov
A
A
Eden
D
D
Bystritski
E
E
Kalina
A
A
Tamir
S
S
Gelman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D001811:Blood Volume Determination / Q000379:methods; D005260:Female; D006438:Hemodilution / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology; D020896:Hypovolemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000379:methods; D013610:Tachycardia; D055815:Young Adult