Non-invasive measurement of pulse pressure variation using a finger-cuff method in obese patients having laparoscopic ba
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ORIGINAL RESEARCH
Non-invasive measurement of pulse pressure variation using a fingercuff method in obese patients having laparoscopic bariatric surgery Moritz Flick1 · Roman Schumann2 · Phillip Hoppe1 · Iwona Bonney2 · Wilbert Wesselink3 · Bernd Saugel1,4 Received: 30 June 2020 / Accepted: 25 October 2020 © The Author(s) 2020
Abstract Pulse pressure variation (PPV) is a dynamic cardiac preload variable used to predict fluid responsiveness. PPV can be measured non-invasively using innovative finger-cuff systems allowing for continuous arterial pressure waveform recording, e.g., the Nexfin system [BMEYE B.V., Amsterdam, The Netherlands; now Clearsight (Edwards Lifesciences, Irvine, CA, USA)] (PPVFinger). However, the agreement between PPVFinger and PPV derived from an arterial catheter (PPVART) in obese patients having laparoscopic bariatric surgery is unknown. We compared PPVFinger and PPVART at 6 time points in 60 obese patients having laparoscopic bariatric surgery in a secondary analysis of a prospective method comparison study. We used Bland–Altman analysis to assess absolute agreement between PPVFinger and P PVART. The predictive agreement for fluid responsiveness between P PVFinger and P PVART was evaluated across three PPV categories (PPV 13%) as concordance rate of paired measurements and Cohen’s kappa. The overall mean of the differences between PPVFinger and PPVART was 0.5 ± 4.6% (95%-LoA − 8.6 to 9.6%) and the overall predictive agreement was 72.4% with a Cohen’s kappa of 0.53. The mean of the differences was − 0.7 ± 3.8% (95%-LoA − 8.1 to 6.7%) without pneumoperitoneum in horizontal position and 1.1 ± 4.8% (95%-LoA − 8.4 to 10.5%) during pneumoperitoneum in reverse-Trendelenburg position. The absolute agreement and predictive agreement between PPVFinger and PPVART are moderate in obese patients having laparoscopic bariatric surgery. Keywords Fluid responsiveness · Dynamic preload variable · Clearsight · Nexfin · Hemodynamic monitoring
1 Introduction
Moritz Flick and Roman Schumann contributed equally to the work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00614-8) contains supplementary material, which is available to authorized users. * Bernd Saugel [email protected] 1
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
2
Department of Anesthesiology and Perioperative Medicine, Tufts University School of Medicine, Boston, MA, USA
3
Edwards Lifesciences, Irvine, CA, USA
4
Outcomes Research Consortium, Cleveland, OH, USA
Pulse pressure variation (PPV) is a dynamic cardiac preload variable used to predict fluid responsiveness [1–3]. PPV results from intermittent changes in venous return and cardiac preload during mechanical ventilation [1, 2]. PPV reliably predicts fluid responsiveness in patients with sinus rhythm and controlled mechanical ventilation with a tidal volume of a
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