Journal of Clinical Monitoring and Computing

, Volume 27, Issue 2, pp 107–111 | Cite as

Respiratory change in ECG-wave amplitude is a reliable parameter to estimate intravascular volume status

  • Raphaël Giraud
  • Nils Siegenthaler
  • Denis R. Morel
  • Jacques-A Romand
  • Laurent Brochard
  • Karim Bendjelid
Original Research

Abstract

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 (ΔECG) compared with respiratory pulse pressure variations (ΔPP), 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. ΔECG was calculated as 100 × [(ECGmax − ECGmin)/(ECGmax + ECGmin)/2]. ΔECG and ΔPP 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, ΔPP and ΔECG were both <12 %. ΔPP were significantly correlated with ΔECG (r2 = 0.89, p < 0.001). Volume loss induced by haemorrhage increased significantly ΔPP and ΔECG. Moreover, during this state, ΔPP were significantly correlated with ΔECG (r2 = 0.86, p < 0.001). Re-transfusion significantly decreased ΔPP and ΔECG, and ΔPP were significantly correlated with ΔECG (r2 = 0.90, p < 0.001). The observed correlations between ΔPP and ΔECG at each time point of the study suggest that ΔECG is a reliable parameter to estimate the changes in intravascular volume status and provide experimental confirmation of the “Brody effect.”

Keywords

ECG Pulse pressure variation Animal study Volemia 

References

  1. 1.
    Young D, Griffiths J. Clinical trials of monitoring in anaesthesia, critical care and acute ward care: a review. Br J Anaesth. 2006;97(1):39–45. doi:10.1093/bja/ael107.PubMedCrossRefGoogle Scholar
  2. 2.
    Brody DA. A theoretical analysis of intracavitary blood mass influence on the heart-lead relationship. Circ Res. 1956;4(6):731–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Giraud R, Siegenthaler N, Morel DR, Bendjelid K. Pre-ejection period to estimate cardiac preload dependency in mechanically ventilated pigs submitted to severe hemorrhagic shock. J Trauma. 2011;71(3):702–7. doi:10.1097/TA.0b013e3181f96823.PubMedCrossRefGoogle Scholar
  4. 4.
    Michard F, Chemla D, Richard C, Wysocki M, Pinsky MR, Lecarpentier Y, Teboul JL. Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP. Am J Respir Crit Care Med. 1999;159(3):935–9.PubMedGoogle Scholar
  5. 5.
    Cannesson M, Keller G, Desebbe O, Lehot JJ. Relations between respiratory changes in R-wave amplitude and arterial pulse pressure in mechanically ventilated patients. J Clin Monit Comput. 2010;24(3):203–7. doi:10.1007/s10877-010-9235-3.PubMedCrossRefGoogle Scholar
  6. 6.
    Bendjelid K, Romand JA. Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med. 2003;29(3):352–60.PubMedGoogle Scholar
  7. 7.
    Feissel M, Michard F, Faller JP, Teboul JL. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004;30(9):1834–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Feissel M, Michard F, Mangin I, Ruyer O, Faller JP, Teboul JL. Respiratory changes in aortic blood velocity as an indicator of fluid responsiveness in ventilated patients with septic shock. Chest. 2001;119(3):867–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Giraud R, Siegenthaler N, Bendjelid K. Pulse pressure variation, stroke volume variation and dynamic arterial elastance. Crit Care. 2011;15(2):414. doi:10.1186/cc10088.PubMedCrossRefGoogle Scholar
  10. 10.
    Feissel M, Teboul JL, Merlani P, Badie J, Faller JP, Bendjelid K. Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med. 2007;33(6):993–9. doi:10.1007/s00134-007-0602-6.PubMedCrossRefGoogle Scholar
  11. 11.
    Bendjelid K. The pulse oximetry plethysmographic curve revisited. Curr Opin Crit Care. 2008;14(3):348–53. doi:10.1097/MCC.0b013e3282fb2dc9.PubMedCrossRefGoogle Scholar
  12. 12.
    Lorne E, Mahjoub Y, Guinot PG, Fournier Y, Detave M, Pila C, Ben Ammar A, Labont B, Zogheib E, Dupont H. Respiratory variations of R-wave amplitude in lead II are correlated with stroke volume variations evaluated by transesophageal Doppler echocardiography. J Cardiothorac Vasc Anesth. 2012;26(3):381–6. doi:10.1053/j.jvca.2012.01.048.PubMedCrossRefGoogle Scholar
  13. 13.
    Soltner C, Dantec R, Lebreton F, Huntzinger J, Beydon L. Changes in R-Wave amplitude in DII lead is less sensitive than pulse pressure variation to detect changes in stroke volume after fluid challenge in ICU patients postoperatively to cardiac surgery. J Clin Monit Comput. 2010;24(2):133–9. doi:10.1007/s10877-010-9221-9.PubMedCrossRefGoogle Scholar
  14. 14.
    Eisenberg MJ, de Romeral LM, Heidenreich PA, Schiller NB, Evans GT Jr. The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment. Chest. 1996;110(2):318–24.PubMedCrossRefGoogle Scholar
  15. 15.
    David D, Kitchen JG 3rd, Michelson EL, Naito M, Sawin HS, Chen CC. R-wave amplitude responses to rapid atrial pacing: a marker for myocardial ischemia. Am Heart J. 1984;107(1):53–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Schick EC Jr, Weiner DA, Hood WB Jr, Ryan TJ. Increase in R-wave amplitude during transient epicardial injury (Prinzmetal type). J Electrocardiol. 1980;13(3):259–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Watanabe K, Bhargava V, Froelicher VF. The relationship between exercise-induced R wave amplitude changes and QRS vector loops. J Electrocardiol. 1981;14(2):129–38.PubMedCrossRefGoogle Scholar
  18. 18.
    David D, Naito M, Michelson E, Watanabe Y, Chen CC, Morganroth J, Shaffenburg M, Blenko T. Intramyocardial conduction: a major determinant of R-wave amplitude during acute myocardial ischemia. Circulation. 1982;65(1):161–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Lekven J, Chatterjee K, Tyberg JV, Parmley WW. Reduction in ventricular endocardial and epicardial potentials during acute increments in left ventricular dimensions. Am Heart J. 1979;98(2):200–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Pinsky MR, Gorcsan J 3rd, Gasior TA, Mandarino WA, Deneault LG, Hattler BG, Kunig H. Changes in electrocardiographic morphology reflect instantaneous changes in left ventricular volume and output in cardiac surgery patients. Am J Cardiol. 1995;76(10):667–74.PubMedCrossRefGoogle Scholar
  21. 21.
    Wood A, Bendjelid SM, Bendjelid K. Primary aortoenteric fistula: should enhanced computed tomography be considered in the diagnostic work-up? Anesth Analg. 2005;101(4):1157–9.Google Scholar
  22. 22.
    Michard F. Volume management using dynamic parameters: the good, the bad, and the ugly. Chest. 2005;128(4):1902–3. doi:10.1378/chest.128.4.1902.

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Raphaël Giraud
    • 1
    • 2
    • 3
  • Nils Siegenthaler
    • 1
    • 2
    • 3
  • Denis R. Morel
    • 2
  • Jacques-A Romand
    • 2
  • Laurent Brochard
    • 1
    • 2
  • Karim Bendjelid
    • 1
    • 2
    • 3
  1. 1.Intensive Care ServiceGeneva University HospitalsGeneva 14Switzerland
  2. 2.Faculty of MedicineUniversity of GenevaGenevaSwitzerland
  3. 3.Faculty of MedicineGeneva Hemodynamic Research Group, University of GenevaGenevaSwitzerland

Personalised recommendations