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Photoplethysmographic and pulse pressure variations during abdominal surgery
Author(s) -
HØISETH L. Ø.,
HOFF I. E.,
SKARE Ø.,
KIRKEBØEN K. A.,
LANDSVERK S. A.
Publication year - 2011
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2011.02527.x
Subject(s) - medicine , abdominal surgery , receiver operating characteristic , anesthesia , plethysmograph , photoplethysmogram , pulse oximetry , pulse pressure , stroke volume , mechanical ventilation , pulse (music) , surgery , blood pressure , heart rate , filter (signal processing) , computer science , computer vision , detector , electrical engineering , engineering
Background Respiratory variations in pulse pressure (Δ PP ) predict fluid responsiveness during mechanical ventilation. Variations in pulse oximetry plethysmography amplitude (Δ POP ) are proposed as a non‐invasive alternative. Large variations in Δ POP and poor agreement between Δ PP and Δ POP are found in intensive care unit patients. General anaesthesia is suggested to reduce variability of Δ POP and improve agreement between the variables. We evaluated the variability of the agreement between and the diagnostic values of Δ PP and Δ POP during ongoing open abdominal surgery. The variability of diagnostic methods in specific clinical conditions is important, as this reflects the stability over time during which clinical decisions are made. Methods Observational study during open abdominal surgery in general anaesthesia. Δ PP and Δ POP were calculated semi‐automatically from recording periods of approximately 5 min both before and after fluid challenges. Fluid responsiveness was evaluated by changes in stroke volume (oesophageal D oppler) after 250 ml colloid. Results Thirty‐four fluid challenges were performed in 25 patients. Variance both within registration periods and between patients were significantly larger for Δ POP than for Δ PP (54.1% vs. 22.1% and 69.6% vs. 22.6%, respectively, both P < 0.001). Limits of agreement with a regression‐based correction were ± 13.9%. Areas under receiver operating characteristics curves for fluid responsiveness were 0.67 for Δ PP and 0.72 for Δ POP . Conclusions Analysis of raw signals during open abdominal surgery documents that the variance of Δ POP is larger than of Δ PP , with wide limits of agreement between Δ PP and Δ POP . The diagnostic values of Δ PP and Δ POP are relatively poor.