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Do changes in perfusion index reflect changes in stroke volume during preload-modifying manoeuvres?

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Abstract

Changes in stroke volume (deltaSV) induced by a lung recruitment manoeuvre (LRM) have been shown to accurately predict fluid responsiveness during protective mechanical ventilation. Cardiac output monitors are used in a limited number of surgical patients. In contrast, all patients are monitored with a pulse oximeter, that may enable the continuous monitoring of a peripheral perfusion index (PI). We postulated that changes in PI (deltaPI) may reflect deltaSV during brief modifications of cardiac preload. We studied 47 patients undergoing neurosurgery and ventilated with a tidal volume of 6–8 ml/kg. All patients were monitored with a pulse contour system enabling the continuous monitoring of SV and with a pulse oximeter enabling the continuous monitoring of PI. LRMs were performed by increasing airway pressure up to 30 cmH20 for 30 s. Fluid loads (250 ml of saline 0.9% in 10 min) were performed only in patients who experienced a deltaSV > 30% during LRMs (potential fluid responders). LRMs induced a 26% decrease in SV (p < 0.05) and a 27% decrease in PI (p < 0.05). We observed a fair relationship between deltaPI and deltaSV (r2 = 0.34). A deltaPI ≥ 26% predicted a deltaSV > 30% with a sensitivity of 83% and a specificity of 78%  (AUC  =  0.84, 95%CI 0.71–0.93). 24 patients experienced a deltaSV > 30% and subsequently received fluid. Fluid loads induced a 16% increase in SV and a 17% increase in PI, but fluid-induced deltaPI and deltaSV were weakly correlated (r2 = 0.19). In neurosurgical patients, we conclude that deltaPI may be used as a surrogate for deltaSV during LRMs but not during fluid loading.

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Funding

Support was provided solely from institutional and/or departmental sources.

Author information

All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Correspondence to Matthieu Biais.

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Conflict of interest

M.B received honoraria from Edwards Lifesciences and Pulsion Medical System as a lecturer. F.M is managing director of MiCo, a Swiss consulting firm. MiCo does not sell any medical products and FM does not own any shares and does not receive any royalties from any MedTech companies. Other authors have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the national research committee (Comité d’Ethique pour la recherche en Anesthésie-Réanimation, IRB-00010254-2018-118) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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de Courson, H., Michard, F., Chavignier, C. et al. Do changes in perfusion index reflect changes in stroke volume during preload-modifying manoeuvres?. J Clin Monit Comput (2019). https://doi.org/10.1007/s10877-019-00445-2

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Keywords

  • Pulse oximeter
  • Lung recruitment manoeuvre
  • Perfusion index
  • Fluid responsiveness
  • Cardiac output