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Continuous noninvasive determination of pulsus paradoxus: a pilot study
D W Steele1, R O Wright, C M Lee
1Department of Emergency Medicine, Rhode Island Hospital, Providence 02903, USA.
Summary
Continuous, noninvasive monitoring of pulsus paradoxus (PP) is feasible using a finger arterial blood pressure (FINAP) monitor. This FINAP method offers better agreement with intra-arterial pressure measurements than manual PP assessments.
Area of Science:
- Cardiology
- Respiratory Medicine
- Biomedical Engineering
Background:
- Pulsus paradoxus (PP) is a critical indicator of respiratory compromise.
- Accurate, continuous, noninvasive monitoring of PP is essential for patient management.
- Existing methods for PP assessment have limitations in accuracy and continuous monitoring.
Purpose of the Study:
- To evaluate the accuracy of two continuous, noninvasive monitoring techniques for pulsus paradoxus (PP).
- To compare noninvasive PP measurements with invasive intra-arterial pressure (IAP) readings.
- To assess the utility of finger arterial blood pressure (FINAP) monitoring and pulse oximeter waveforms for PP detection.
Main Methods:
- Experimentally induced varying degrees of PP in a healthy adult.
- Continuously recorded intra-arterial pressure (IAP), finger arterial blood pressure (FINAP), and pulse oximeter waveforms.
- Compared PP measurements from FINAP (PPFINAP) and manual readings (PPmanual) against IAP (PPIAP).
Main Results:
- PPFINAP demonstrated high correlation with PPIAP (r = 0.96).
- Manual PP measurements showed weak correlation with PPIAP (r = 0.27).
- Pulse oximeter waveform analysis (%PWDpleth) showed moderate correlation with PPIAP (r = 0.59).
Conclusions:
- Continuous, noninvasive pulsus paradoxus (PP) measurement is accurate using a FINAP monitor.
- FINAP monitoring shows superior agreement with invasive IAP measurements compared to manual PP assessment.
- Pulse oximeter waveform analysis is a less accurate but potentially useful screening tool for significant PP.