Significance of Peripheral Perfusion Changes During Remote Ischemic Conditioning in Critically Ill Patients

Objectives: This study aims to evaluate whether changes in perfusion index (PI) after the first deflation of the blood pressure cuff during remote ischemic conditioning (RIC) are associated with passive leg raising (PLR)-induced changes in stroke volume. In addition, we compared PI changes after cuff deflation during RIC between critically ill patients and healthy controls. Methods: This prospective, single-center study was conducted in a mixed ICU at a tertiary teaching hospital. Patients aged >18 years admitted to the ICU, monitored using calibrated pulse contour analysis, and scheduled for a PLR test as decided by the attending physicians were included. The PI was measured after blood pressure cuff deflations during RIC (3 cycles of brachial cuff inflation to 200 mmHg for 5 min, followed by instantaneous deflation to 0 mmHg for another 5 min) in the supine position after PLR. Preload responsiveness was defined as a ≥10% increase in the stroke volume index (SVI) during PLR. Data were compared with a healthy control group. Results: Thirty-three patients were included (median age 62; 45% in shock; 55% mechanically ventilated). When comparing critically ill patients with healthy volunteers, the maximum PI change (dPImax) and the time to reach it were higher in critically ill patients after the first and second cuff deflations (p < 0.05). However, after the third deflation, the difference was no longer significant. Following the first deflation, dPImax was significantly correlated with SVI changes during PLR (r = 0.63, p < 0.001). After the cuff was first deflated, we detected a PI cutoff with a positive SVI response (≥10%) during PLR, with a sensitivity of 64% and a specificity of 94% (area under the receiver operating characteristic curve 0.752; 95% CI, 0.564-0.940; p = 0.008). Conclusions: The maximum change in perfusion index following brachial blood pressure cuff deflation after five minutes of inflation may serve as a promising noninvasive bedside indicator of preload responsiveness in critically ill patients. Additionally, the observed normalization of PI kinetics during RIC suggests possible acute modulation of vascular reactivity, though further research is needed to confirm an association between PI changes and endothelial function.