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Continuous Noninvasive Determination of Pulsus Paradoxus: A Pilot Study
Author(s) -
Steele Dale W.,
Wright Robert O.,
Lee Calvin M.,
Jay Gregory D.
Publication year - 1995
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.1995.tb03105.x
Subject(s) - medicine , pulse pressure , cardiology , blood pressure , pulse (music) , nuclear medicine , detector , electrical engineering , engineering
Objective: To evaluate two methods of continuous, noninvasive monitoring of pulsus paradoxus (PP). Methods: A single‐subject, nonblind assessment was conducted of the ability of noninvasive monitoring techniques to measure experimentally induced PP. Variable degrees of PP were induced in a healthy adult breathing through a oneway valve to which a series of external airway resistances were added. Intra‐arterial pressure (IAP), finger arterial blood pressure (FINAP), pulse oximeter pulse waveform, and chest wall motion were continuously recorded. For each resistance, PP was calculated from the IAP (PP IAP ) and the FINAP (PP FINAP ) recordings. PP was measured manually (PP manual ) in the opposite arm. The percentage pulse waveform decrease on inspiration (%PWD pleth ) was derived from the oximeter pulse waveform. These measurements were compared with the PP IAP . Bias was assessed as the mean difference between PP measures. Results: PP FINAP , was highly correlated with PP IAP (r = 0.96; 95% CI 0.93 to 0.98; p < 0.0001). There was a weak correlation between PP manual and PP IAP (r = 0.27; 95% CI ‐0.05 to 0.55; p = 0.0963). The %PWD pleth correlated with PP IAP (r = 0.59, 95% CI 0.32 to 0.78; p = 0.0002). Bias was ‐1.515 ± 5.6 mm Hg between PP IAP and PP FINAP ; and ‐4.508 ± 23.4 mm Hg between PP IAP and PP manual . Conclusion: An accurate and continuous PP can be measured noninvasively using a FINAP monitor. This method has much better agreement with IAP measurements than do manual measurements. The qualitative information provided by the oximeter pulse waveform is less accurate than that provided by the FINAP monitor, but is a potentially useful screening tool for detection of significant PP.