J Clin Monit Comput - Pulse-plethysmographic variables in hemodynamic assessment during mannitol infusion.


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Plethysmographic signal using pulse oximetry may be used to assess fluid status of patients during surgery as it resembles arterial pressure waveform. This will avoid placement of invasive arterial lines. This study was designed to find out whether intravascular volume changes induced by mannitol bolus in neurosurgical patients are detected by variations in arterial pressure and plethysmographic waveforms and also to assess the strength of correlation between different variables derived from these two waveforms. The time difference between the onset of arterial and plethysmographic waveforms as means of significant hemodynamic changes was also evaluated. Forty one adult ASA I and II neurosurgical patients requiring mannitol infusion were recruited. Arterial line and plethysmographic probe were placed in the same limb. Digitized waveforms were collected before, at the end, and 15, 30 and 60?min after mannitol infusion. Using MATLAB, the following parameters were collected for three consecutive respiratory cycles,-systolic pressure variation (SPV), pulse pressure variation (PPV), plethysmographic peak variation (Pl-PV), plethysmographic amplitude variation (Pl-AV) and blood pressure-plethysmographic time lag (BP-Pleth time lag). Changes in above parameters over the study period were studied using repeated measure analysis of variance. Correlation between the parameters was analysed. SPV and Pl-PV showed significant increase at 15, 30 and 60?min compared to end of mannitol infusion (P?<?0.01 for SPV; P?<?0.05 for Pl-PV). PPV and Pl-AV showed significant increase only at 30?min (P?<?0.05). The correlation between SPV-Pl-PV, PPV-Pl-AV and SPV-BP-Pleth time lag were significant (r?=?0.3; P?<?0.01). SPV and time lag had no significant interaction. Pl-PV correlates well with SPV following mannitol infusion and can be used as an alternative to SPV. (BP-Pleth) time-lag promises to be an important parameter in assessing the state of peripheral vascular resistance and deserves further investigation.

Resumo Limpo

plethysmograph signal use puls oximetri may use assess fluid status patient surgeri resembl arteri pressur waveform will avoid placement invas arteri line studi design find whether intravascular volum chang induc mannitol bolus neurosurg patient detect variat arteri pressur plethysmograph waveform also assess strength correl differ variabl deriv two waveform time differ onset arteri plethysmograph waveform mean signific hemodynam chang also evalu forti one adult asa ii neurosurg patient requir mannitol infus recruit arteri line plethysmograph probe place limb digit waveform collect end min mannitol infus use matlab follow paramet collect three consecut respiratori cyclessystol pressur variat spv puls pressur variat ppv plethysmograph peak variat plpv plethysmograph amplitud variat plav blood pressureplethysmograph time lag bppleth time lag chang paramet studi period studi use repeat measur analysi varianc correl paramet analys spv plpv show signific increas min compar end mannitol infus p spv p plpv ppv plav show signific increas min p correl spvplpv ppvplav spvbppleth time lag signific r p spv time lag signific interact plpv correl well spv follow mannitol infus can use altern spv bppleth timelag promis import paramet assess state peripher vascular resist deserv investig

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