Korean J Crit Care Med.  2008 Jun;23(1):6-12. 10.4266/kjccm.2008.23.1.6.

Variations in Pulse Oximetry Plethysmographic Waveform Amplitude and Hemodynamic Assessment Induced by Passive Leg Raising in Spontaneously Breathing Adult Volunteers

Affiliations
  • 1Department of Emergency Medicine, Kwandong University College of Medicine, Goyang, Korea. erman@kwandong.ac.kr
  • 2Department of Chest Surgery, Kwandong University College of Medicine, Goyang, Korea.

Abstract

BACKGROUND: In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsivenss is a difficult challenge. Our objective was to test whether the respiratory changes in pulse oxymetry plethysmographic waveform amplitude (POP) and in stroke volume (deltaSV) could predict fluid responsiveness to passive leg raising (PLR) in normal volunteers.
METHODS
We investigated 25 normal volunteers. We assessed hemodynamic status (HR, SBP, MAP, CI and SVI) and calculated the respiratory variation in pulse oximetry plethysmographic waveform amplitude at supine and after PLR. We attached a pulse oximeter of 25 spontaneously breathing volunteers as several time points: after 1 min and 5 min in supine position and during PLR at 60degrees. Heart rate, non-invasive blood pressures (mean arterial pressure, systolic blood pressure), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP defined as (POPmax-POPmin)/[(POPmax+POPmin)/2] were recorded using monitor.
RESULTS
Comparing to supine and PLR, systolic blood pressure and mean arterial pressure were not different, but the change in cardiac index, stroke volume and respiratory variation in POP were significant different. In response group (> or =10% in deltaCI), the change in cardiac index, stroke volume and respiratory variation in POP were significant greater.
CONCLUSION
PLR induces a significant decrement of variation in POP amplitude among spontaneouely breathing volunteers. We suppose that the changes in stroke volume and the respiratory variation in pulse oximetry plethysmographic waveform amplitude induced by PLR predict fluid responsiveness in spontaneous breathing patients.

Keyword

Fluid responsiveness (FL); Passive leg raising (PLR); Pulse oximetry plethysmographic waveform (POP)

MeSH Terms

Adult
Arterial Pressure
Blood Pressure
Heart Rate
Hemodynamics
Humans
Leg
Organothiophosphorus Compounds
Oximetry
Respiration
Stroke Volume
Supine Position
Organothiophosphorus Compounds
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