title: Limitations of stroke volume estimation by non-invasive blood pressure monitoring in hypergravity.
abstract: BACKGROUND
  Altitude and gravity changes during aeromedical evacuations induce exacerbated cardiovascular responses in unstable patients. Non-invasive cardiac output monitoring is difficult to perform in this environment with limited access to the patient. We evaluated the feasibility and accuracy of stroke volume estimation by finger photoplethysmography (SVp) in hypergravity.
  
  
  METHODS
  Finger arterial blood pressure (ABP) waveforms were recorded continuously in ten healthy subjects before, during and after exposure to +Gz accelerations in a human centrifuge. The protocol consisted of a 2-min and 8-min exposure up to +4 Gz. SVp was computed from ABP using Liljestrand, systolic area, and Windkessel algorithms, and compared with reference values measured by echocardiography (SVe) before and after the centrifuge runs.
  
  
  RESULTS
  The ABP signal could be used in 83.3% of cases. After calibration with echocardiography, SVp changes did not differ from SVe and values were linearly correlated (p<0.001). The three algorithms gave comparable SVp. Reproducibility between SVp and SVe was the best with the systolic area algorithm (limits of agreement -20.5 and +38.3 ml).
  
  
  CONCLUSIONS
  Non-invasive ABP photoplethysmographic monitoring is an interesting technique to estimate relative stroke volume changes in moderate and sustained hypergravity. This method may aid physicians for aeronautic patient monitoring.
authors: Percy Military Hospital, Aeromedical Centre, Clamart, France.
authors: Olivier
authors: O
authors: Manen
authors: Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France.
authors: Caroline
authors: C
authors: Dussault
authors: Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France; EA7330 VIFASOM, Paris Descartes University, Hotel Dieu, Paris, France.
authors: Fabien
authors: F
authors: Sauvet
authors: Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France.
authors: Stéphanie
authors: S
authors: Montmerle-Borgdorff
mesh_terms: D000328:Adult; D000465:Algorithms; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D005385:Fingers / Q000098:blood supply; D006801:Humans; D018471:Hypergravity; D008297:Male; D017156:Photoplethysmography; D015203:Reproducibility of Results; D012815:Signal Processing, Computer-Assisted; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole; D013997:Time Factors