The effect of positive end-expiratory pressure and tripled tidal volume on pleth variability index during hypovolaemia in conscious subjects A volunteer study
2013 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 30, no 11, 671-677 p.Article in journal (Refereed) Published
BACKGROUNDThe pulse oximeter measurement pleth variability index (PVI) can detect hypovolaemia during positive pressure ventilation.OBJECTIVESWe studied whether PVI can detect a hypovolaemic state in spontaneously breathing humans and whether better discrimination is obtained by modifying the breathing patterns.DESIGNExperimental study.SETTINGClinical physiology department in a university hospital.PARTICIPANTSFourteen healthy volunteers aged between 18 and 27 (mean 21) years.INTERVENTIONSA hypovolaemic state was induced by lower body negative pressure (LBNP) of 40mmHg (LBNP40) and 15mmHg (LBNP15). Data were collected in four separate series with normal breathing and application of positive end-expiratory pressure (PEEP) 5cmH(2)O, with and without tripling of the tidal volume.MAIN OUTCOME MEASURESPVI (meanstandard deviation), heart rate, arterial blood pressure and cardiac index (CI).RESULTSCardiac index decreased from 2.4 to 1.7 and 2.1 lmin(-1)m(-2) at LBNP40 and LBNP15, respectively (Pandlt;0.001). The mean PVI for the four breathing modes increased with the degree of LBNP, from 23.55.9% at baseline to 27.9 +/- 9.3% at LBNP40, and to 25.2 +/- 6.9% at LBNP15 (Pandlt;0.01). The greatest increase in PVI, to 31.7 +/- 12.3%, was recorded for the PEEP and tripled tidal volume breathing mode when hypovolaemia was induced by LBNP40. However, there was considerable overlap between the LBNP levels.CONCLUSIONThe PVI increased significantly for higher LBNP, but overlap was common regardless of breathing mode. The PVI can be used to indicate a hypovolaemic state during spontaneous breathing in groups but not in individuals.TRIAL REGISTRATIONClinicaltrials.gov identifier NCT01456559
Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS and WILKINS, 530 WALNUT ST, PHILADELPHIA, PA 19106-3621 USA , 2013. Vol. 30, no 11, 671-677 p.
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-102083DOI: 10.1097/EJA.0b013e32836394c0ISI: 000326597300006OAI: oai:DiVA.org:liu-102083DiVA: diva2:668945
Funding Agencies|County Council of Ostergotland||Futurum the Academy of Healthcare, Jonkoping County Council||2013-12-022013-11-292015-06-08