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Pulse-plethysmographic variables in hemodynamic assessment during mannitol infusion

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Abstract

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.

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Conflict of interest

None of the authors has any conflict of interest in the material under consideration for publication.

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Authors and Affiliations

  1. Department of Neuroanaesthesia, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, 560029, India

    M. Radhakrishnan, S. Veena & G. S. Umamaheswara Rao

  2. Society for Biomedical Technology, DEBEL, ADE Campus, New Thippasandra, Bangalore, 560075, India

    K. Mohanvelu & G. Sripathy

Authors
  1. M. Radhakrishnan
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  2. K. Mohanvelu
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  3. S. Veena
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  4. G. Sripathy
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  5. G. S. Umamaheswara Rao
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Corresponding author

Correspondence to G. S. Umamaheswara Rao.

Appendix

Appendix

Figures 6, 7, 8, 9, 10 and 11 representing individual analyses of dorsalis pedis and radial artery.

Fig. 6
figure 6

SPV (mmHg) and (BP-Pleth) time lag (sec) changes in dorsalis pedis artery (P = 0.03; Interaction—not significant; Error bars represent SEM)

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Fig. 7
figure 7

SPV (mmHg) and (BP-Pleth) time lag (sec) changes in radial artery (P = 0.02; Interaction—not significant; Error bars represent SEM)

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Fig. 8
figure 8

Systolic pressure variation (SPV) (mmHg) and peak plethysmographic variation (PplV) radial artery (P = 0.03; Interaction—not significant; Error bars represent SEM)

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Fig. 9
figure 9

Systolic pressure variation (SPV) (mmHg) and peak plethysmographic variation (PplV) in dorsalis pedis artery (P = 0.03; Interaction—not significant; Error bars represent SEM)

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Fig. 10
figure 10

Δ (BP-Pleth) Time lag (sec) versus Δ SPV (mmHg) in dorsalis pedis artery (P < 0.001)

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Fig. 11
figure 11

Δ (BP-Pleth) Time lag (sec) versus Δ SPV (mmHg) in radial artery (P < 0.001)

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Radhakrishnan, M., Mohanvelu, K., Veena, S. et al. Pulse-plethysmographic variables in hemodynamic assessment during mannitol infusion. J Clin Monit Comput 26, 99–106 (2012). https://doi.org/10.1007/s10877-012-9339-z

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  • DOI: https://doi.org/10.1007/s10877-012-9339-z

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