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Photoplethysmographic and pulse pressure variations during abdominal surgery
L Ø Høiseth1, I E Hoff, O Skare
1Department of Anaesthesiology, Oslo University Hospital, Norway. lars.oivind.hoiseth@hotmail.com
Acta Anaesthesiologica Scandinavica
|November 19, 2011
Summary
Respiratory variations in pulse pressure (ΔPP) and pulse oximetry plethysmography amplitude (ΔPOP) show poor agreement and high variability during abdominal surgery. Both methods offer limited diagnostic value for fluid responsiveness in this setting.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Cardiovascular Physiology
Background:
- Respiratory variations in pulse pressure (ΔPP) predict fluid responsiveness in ventilated patients.
- Variations in pulse oximetry plethysmography amplitude (ΔPOP) are a proposed non-invasive alternative.
- Previous studies show high variability and poor agreement between ΔPP and ΔPOP in ICUs.
Purpose of the Study:
- To evaluate the variability and agreement between ΔPP and ΔPOP during open abdominal surgery.
- To assess the diagnostic values of ΔPP and ΔPOP for predicting fluid responsiveness in this specific clinical context.
Main Methods:
- Observational study conducted during open abdominal surgery under general anesthesia.
- Semi-automatic calculation of ΔPP and ΔPOP from 5-minute recordings before and after fluid challenges.
- Fluid responsiveness assessed by changes in stroke volume measured via esophageal Doppler after 250 ml colloid administration.
Main Results:
- Thirty-four fluid challenges were analyzed in 25 patients.
- Variance was significantly higher for ΔPOP (54.1% within periods, 69.6% between patients) compared to ΔPP (22.1% vs. 22.6%).
- Regression-corrected limits of agreement were ±13.9%; AUCs for fluid responsiveness were 0.67 for ΔPP and 0.72 for ΔPOP.
Conclusions:
- The variance of ΔPOP is significantly greater than ΔPP during open abdominal surgery.
- Wide limits of agreement exist between ΔPP and ΔPOP, indicating poor interchangeability.
- Both ΔPP and ΔPOP demonstrate relatively poor diagnostic accuracy for predicting fluid responsiveness in this surgical setting.
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