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Updated: Jul 12, 2026
Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography
Published on: October 11, 2022
Noninvasive peripheral perfusion index as a possible tool for screening for critical left heart obstruction
A de-Wahl Granelli1, I Ostman-Smith
1Department of Paediatrics, The Institute of Clinical Sciences, The Sahlgrenska Academy, Gothenburg University, Sweden.
Aim:
Peripheral perfusion index (PPI) has been suggested as a possible method to detect illness causing circulatory embarrassment. We aimed to establish the normal range of this index in healthy newborns, and compare it with newborns with duct-dependent systemic circulation.
Design:
We conducted a case-control study.
Setting:
Our study population comprised 10,000 prospectively recruited newborns from Västra Götaland, Sweden.
Patients:
A total of 10,000 normal newborns and 9 infants with duct-dependent systemic circulation (left heart obstructive disease [LHOD] group) participated in the study.
Methods:
We conducted single pre- and postductal measurements of PPI with a new generation pulse oximeter (Masimo Radical SET) before discharge from hospital.
Results:
PPI values between 1 and 120 h of age show an asymmetrical, non-normal distribution with median PPI value of 1.70 and interquartile range of 1.18-2.50. The 5th percentile = 0.70 and 95th percentile = 4.50. All infants in the LHOD group had either pre- or postductal PPI below the interquartile range, and 5 of 9 (56%) were below the 5th percentile cut-off of 0.70 (p < 0.0001, Fisher's exact test). A PPI value <0.70 gave an odds ratio for LHOD of 23.75 (95% CI 6.36-88.74).
Conclusion:
PPI values lower than 0.70 may indicate illness and a value <0.50 (1st percentile) indicates definite underperfusion. PPI values might be a useful additional tool for early detection of LHOD.
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