title: Noninvasive continuous arterial pressure measurements in the assessment of acute, severe central hypovolemia.
abstract: Acute, severe hypovolemia is a medical emergency. Traditional vital sign parameters allow no optimal triage. High predictive power of finger plethysmography-based stroke volume (SV) and pulse pressure (PP) was recently suggested. To assess the performance of the PP and SV parameters, lower body negative pressure of -40 mmHg, than -60 mmHg - corresponding to moderate and severe central hypovolemia - was applied in 22 healthy males (age 35 ± 7 years). Slow breathing induced fluctuations in the above indices, characterized by stroke volume variability (SVV), and pulse pressure variability (PPV), were assessed. Responses in heart rate (HR) and shock index (SI) were also studied. Discriminative capacity of these parameters was characterized by the area under the ROC (receiver operating characteristic) curves (AUC).
  
  
  RESULTS
  In comparison of baseline to severe central hypovolemia SV, PP, HR, and SI showed good discriminating capacity (AUC 99%, 88%, 87%, and 93%, respectively). The discriminating capacity of SVV and PPV was poor (77% and 70%, respectively). In comparison of moderate and severe hypovolemia, the discriminating capacity of the studied parameters was uniformly limited.
  
  
  CONCLUSIONS
  Plethysmography-based SV and PP parameters can be used to detect acute severe volume loss. Sensitive parameters discriminating moderate and severe central hypovolemia are still lacking.
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: J
authors: J
authors: Simon
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: T
authors: T
authors: Farkas
authors: University of Szeged Department of Technical Informatics Szeged Hungary.
authors: Z
authors: Z
authors: Gingl
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: A
authors: A
authors: Csillik
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: A
authors: A
authors: Korsós
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: László
authors: L
authors: Rudas
authors: University of Szeged Department of Anesthesiology and Intensive Care, Faculty of Medicine Korányi fasor 7 H-6720 Szeged Hungary.
authors: É
authors: É
authors: Zöllei
mesh_terms: D000208:Acute Disease; D000328:Adult; D019540:Area Under Curve; D062186:Arterial Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography / Q000379:methods*; D063177:Pulse Wave Analysis / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: central hypovolemia; noninvasive finger blood pressure monitoring; pulse pressure; stroke volume