J Clin Monit Comput - Respiratory change in ECG-wave amplitude is a reliable parameter to estimate intravascular volume status.

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Resumo

Electrocardiogram (ECG) is a standard type of monitoring in intensive care medicine. Several studies suggest that changes in ECG morphology may reflect changes in volume status. The "Brody effect", a theoretical analysis of left ventricular (LV) chamber size influence on QRS-wave amplitude, is the key element of this phenomenon. It is characterised by an increase in QRS-wave amplitude that is induced by an increase in ventricular preload. This study investigated the influence of changes in intravascular volume status on respiratory variations of QRS-wave amplitudes (ECG) compared with respiratory pulse pressure variations (PP), considered as a reference standard. In 17 pigs, ECG and arterial pressure were recorded. QRS-wave amplitude was measured from the Biopac recording to ensure that in all animals ECG electrodes were always at the same location. Maximal QRS amplitude (ECGmax) and minimal QRS amplitude (ECGmin) were determined over one respiratory cycle. ECG was calculated as 100??[(ECGmax?-?ECGmin)/(ECGmax?+?ECGmin)/2]. ECG and PP were simultaneously recorded. Measurements were performed at different time points: during normovolemic conditions, after haemorrhage (25?mL/kg), and following re-transfusion (25?mL/kg) with constant tidal volume (10?mL/kg) and respiration rate (15 breath/min). At baseline, PP and ECG were both <12?%. PP were significantly correlated with ECG (r(2)?=?0.89, p?<?0.001). Volume loss induced by haemorrhage increased significantly PP and ECG. Moreover, during this state, PP were significantly correlated with ECG (r(2)?=?0.86, p?<?0.001). Re-transfusion significantly decreased PP and ECG, and PP were significantly correlated with ECG (r(2)?=?0.90, p?<?0.001). The observed correlations between PP and ECG at each time point of the study suggest that ECG is a reliable parameter to estimate the changes in intravascular volume status and provide experimental confirmation of the "Brody effect."

Resumo Limpo

electrocardiogram ecg standard type monitor intens care medicin sever studi suggest chang ecg morpholog may reflect chang volum status brodi effect theoret analysi left ventricular lv chamber size influenc qrswave amplitud key element phenomenon characteris increas qrswave amplitud induc increas ventricular preload studi investig influenc chang intravascular volum status respiratori variat qrswave amplitud ecg compar respiratori puls pressur variat pp consid refer standard pig ecg arteri pressur record qrswave amplitud measur biopac record ensur anim ecg electrod alway locat maxim qrs amplitud ecgmax minim qrs amplitud ecgmin determin one respiratori cycl ecg calcul ecgmaxecgminecgmaxecgmin ecg pp simultan record measur perform differ time point normovolem condit haemorrhag mlkg follow retransfus mlkg constant tidal volum mlkg respir rate breathmin baselin pp ecg pp signific correl ecg r p volum loss induc haemorrhag increas signific pp ecg moreov state pp signific correl ecg r p retransfus signific decreas pp ecg pp signific correl ecg r p observ correl pp ecg time point studi suggest ecg reliabl paramet estim chang intravascular volum status provid experiment confirm brodi effect

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