Do changes in perfusion index reflect changes in stroke volume during preload-modifying manoeuvres?
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ORIGINAL RESEARCH
Do changes in perfusion index reflect changes in stroke volume during preload-modifying manoeuvres? Hugues de Courson1 · Frédéric Michard2 · Camille Chavignier1 · Eric Verchère1 · Karine Nouette‑Gaulain1,3,4 · Matthieu Biais1,4,5 Received: 7 November 2019 / Accepted: 11 December 2019 © Springer Nature B.V. 2019
Abstract Changes in stroke volume (deltaSV) induced by a lung recruitment manoeuvre (LRM) have been shown to accurately predict fluid responsiveness during protective mechanical ventilation. Cardiac output monitors are used in a limited number of surgical patients. In contrast, all patients are monitored with a pulse oximeter, that may enable the continuous monitoring of a peripheral perfusion index (PI). We postulated that changes in PI (deltaPI) may reflect deltaSV during brief modifications of cardiac preload. We studied 47 patients undergoing neurosurgery and ventilated with a tidal volume of 6–8 ml/kg. All patients were monitored with a pulse contour system enabling the continuous monitoring of SV and with a pulse oximeter enabling the continuous monitoring of PI. LRMs were performed by increasing airway pressure up to 30 cmH20 for 30 s. Fluid loads (250 ml of saline 0.9% in 10 min) were performed only in patients who experienced a deltaSV > 30% during LRMs (potential fluid responders). LRMs induced a 26% decrease in SV (p 30% and subsequently received fluid. Fluid loads induced a 16% increase in SV and a 17% increase in PI, but fluid-induced deltaPI and deltaSV were weakly correlated ( r2 = 0.19). In neurosurgical patients, we conclude that deltaPI may be used as a surrogate for deltaSV during LRMs but not during fluid loading. Keywords Pulse oximeter · Lung recruitment manoeuvre · Perfusion index · Fluid responsiveness · Cardiac output
1 Introduction All patients undergoing surgery are monitored with a pulse oximeter enabling the continuous monitoring of peripheral oxygen saturation ( SpO2). The ratio of the pulsatile to the non-pulsatile component of the pulse oximetry waveform
is called the peripheral perfusion index (PI). It is displayed by most commercially available pulse oximeters and often used as a signal quality indicator. The PI depends both on blood flow and on vascular tone [1–3]. As a result, it is not possible to estimate cardiac output or sympathetic activity from absolute PI measurements. However, tracking
* Matthieu Biais matthieu.biais@chu‑bordeaux.fr
1
Department of Anaesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, 33000 Bordeaux, France
Hugues de Courson [email protected]
2
MiCo, Chemin de Chapallaz 4, Denens, Switzerland
3
INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), Bordeaux, France
4
University of Bordeaux, Bordeaux, France
5
INSERM, U1034, Biology of Cardiovascular Diseases, 33600 Pessac, France
Frédéric Michard [email protected] Camille Chavignier [email protected] Eric Verchère eric.verchere@chu‑bordeaux.fr Karine Nouette‑Gaulain karine.
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