J Korean Soc Emerg Med.  2009 Aug;20(4):379-384.

Can Pulse Oximetry Plethysmography Waveform Amplitude in Respiratory Variations Predict fluid Responsiveness on Spontaneously Breathing Adult Shock Patients?

• Park YS
• Ko JW
• Chung SW
• Moon DS
• Kim IB

Abstract

PURPOSE: It is difficult to predict volume responsiveness in hemodynamically unstable patients with spontaneous breathing activity. Our objective was to test whether the respiratory variations in pulse oximetry plethysmography (POP) waveform amplitude could predict fluid responsiveness to fluid resuscitation (FR) in spontaneously breathing adult shock patients.
METHODS
We investigated 21 patients presenting with shock in the Emergency Room. We assessed hemodynamic status and calculated the respiratory variations in POP waveform amplitude before and after FR. Heart rate, blood pressures (MAP, SBP), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP, defined as deltaPOP = (POPmax - POPmin) / ([POPmax + POPmin] / 2) were recorded. We measured hemodynamic parameters by doppler ultrasound, USCOM(R).
RESULTS
Comparisons of hemodynamic parameters between before and after FR showed no significant difference in heart rate, but POP showed significant differences in changes in SBP, MAP, cardiac index, stroke volume index and respiratory variations. In response group(> or =15% in delta CI), the change in cardiac index, stroke volume index, and the respiratory variation in the POP were not significantly different.
CONCLUSION
In spontaneously breathing patients with shock, we suggest that delta POP is not a reliable parameter in the prediction of fluid responsiveness.

Keyword

Fluid resuscitation; Fluid Responsiveness; Pulse oximetry plethysmographic waveform amplitude; POP

MeSH Terms

Adult
Emergencies
Heart Rate
Hemodynamics
Humans
Oximetry
Plethysmography
Respiration
Resuscitation
Shock
Stroke Volume