J Clin Monit Comput - Variations in the pre-ejection period induced by deep breathing do not predict the hemodynamic response to early haemorrhage in healthy volunteers.

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Resumo

Monitoring that can predict fluid responsiveness is an unsettled matter for spontaneously breathing patients. Mechanical ventilation induces cyclic variations in blood pressure, e.g. pulse pressure variation, whose magnitude predicts fluid responsiveness in mechanically ventilated patients. In this study, we hypothesised that a deep breathing manoeuvre with its effect on heart rate variability (HRV) could induce similar cyclic variations in blood pressure in spontaneously breathing healthy subjects and that the magnitude of these variations could predict the hemodynamic response to controlled haemorrhage. 37 blood donors were instructed to perform two simple deep breathing manoeuvres prior to blood donation; one manoeuvre with a respiratory cycle every 10 s (0.1 Hz) and one every 6 s (0.167 Hz). The variation in the pre-ejection period (PEP) was captured with the electrocardiographic and plethysmographic curves, while the hemodynamic response to haemorrhage was estimated with the cardiac output change assessed with ultrasonography. Respiratory HRV was estimated with root mean square of successive differences (RMSSD). Deep breathing induced cyclic changes in PEP magnitude was significantly correlated to RMSSD (p < 0.005). PEP indexed to RMSSD increased significantly following haemorrhage at the 0.167 Hz respiratory frequency (p = 0.01). At none of the respiratory manoeuvres was PEP nor PEP/RMSSD prior to haemorrhage correlated to changes in cardiac output following haemorrhage. Deep breathing induces cyclic changes in blood pressure that are strongly dependent on HRV. These blood pressure variations do, however, not predict the cardiac output response to controlled haemorrhage.

Resumo Limpo

monitor can predict fluid respons unsettl matter spontan breath patient mechan ventil induc cyclic variat blood pressur eg puls pressur variat whose magnitud predict fluid respons mechan ventil patient studi hypothesis deep breath manoeuvr effect heart rate variabl hrv induc similar cyclic variat blood pressur spontan breath healthi subject magnitud variat predict hemodynam respons control haemorrhag blood donor instruct perform two simpl deep breath manoeuvr prior blood donat one manoeuvr respiratori cycl everi s hz one everi s hz variat preeject period pep captur electrocardiograph plethysmograph curv hemodynam respons haemorrhag estim cardiac output chang assess ultrasonographi respiratori hrv estim root mean squar success differ rmssd deep breath induc cyclic chang pep magnitud signific correl rmssd p pep index rmssd increas signific follow haemorrhag hz respiratori frequenc p none respiratori manoeuvr pep peprmssd prior haemorrhag correl chang cardiac output follow haemorrhag deep breath induc cyclic chang blood pressur strong depend hrv blood pressur variat howev predict cardiac output respons control haemorrhag

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