J Clin Monit Comput - The relationship between the area of peripherally-derived pressure volume loops and systemic vascular resistance.

Tópicos

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Resumo

Arterial and photoplethysmographic (PPG) waveforms have been utilized to non-invasively estimate stroke volume from the pulse contour. The ability of these pulse contour devices to accurately predict stroke volume is degraded when afterload changes significantly. There is a need for a non-invasive device capable of identifying when vascular tone has changed. Shelley et al. previously described a qualitative relationship between peripheral pressure volume (PV) loops (in which pressure waveforms from an intra-arterial catheter are combined with volume waveforms from the PPG waveform) and changes in vascular tone. The purpose of this study was to quantitatively compare changes in the area of peripheral PV loops with changes in systemic vascular resistance (SVR) in a patient population undergoing major surgery. Physiologic data from ten patients undergoing liver transplantation was extracted from a hemodynamic database. A peak detection algorithm was applied to both the arterial and PPG waveforms, which were manually aligned so that the troughs occurred at identical time points. PV loop area (PVA) for each heartbeat was calculated and median PVA was recorded for each minute. PVA for each patient was indexed to the average value for the first 5?min (because PPG amplitude has no standard and is not comparable between patients) and compared to indexed SVR at all points for which SVR was available. SVR and PVA were plotted as a function of time and outliers (3.1?%) removed. The Pearson correlation coefficient describing the relationship between PVAi and SVRi was 0.67 (1,728?min of data, p?=?0.0020, sign test over 10 patients) and between MAP and SVR was 0.71. There was no meaningful correlation between SVR and either PVA or MAP (based on minute-to-minute changes). Indexed values of PVA are correlated with indexed values of SVR and may serve as a useful monitor for changes in afterload but in their present form do not offer added value above the measurement of MAP. Incorporation of different (e.g. finger, forehead) and redundant (e.g. bilateral) sites may significantly improve the accuracy of this technique.

Resumo Limpo

arteri photoplethysmograph ppg waveform util noninvas estim stroke volum puls contour abil puls contour devic accur predict stroke volum degrad afterload chang signific need noninvas devic capabl identifi vascular tone chang shelley et al previous describ qualit relationship peripher pressur volum pv loop pressur waveform intraarteri cathet combin volum waveform ppg waveform chang vascular tone purpos studi quantit compar chang area peripher pv loop chang system vascular resist svr patient popul undergo major surgeri physiolog data ten patient undergo liver transplant extract hemodynam databas peak detect algorithm appli arteri ppg waveform manual align trough occur ident time point pv loop area pva heartbeat calcul median pva record minut pva patient index averag valu first min ppg amplitud standard compar patient compar index svr point svr avail svr pva plot function time outlier remov pearson correl coeffici describ relationship pvai svri min data p sign test patient map svr meaning correl svr either pva map base minutetominut chang index valu pva correl index valu svr may serv use monitor chang afterload present form offer ad valu measur map incorpor differ eg finger forehead redund eg bilater site may signific improv accuraci techniqu

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