Evaluation of least significant changes of pulse contour analysis-derived parameters

Hugues de Courson, Loic Ferrer, Grégoire Cane, Eric Verchère, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais, Hugues de Courson, Loic Ferrer, Grégoire Cane, Eric Verchère, Musa Sesay, Karine Nouette-Gaulain, Matthieu Biais

Abstract

Background: Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT®, Pulsion Medical System, Germany).

Methods: In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute.

Results: Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation.

Conclusion: To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.

Keywords: Precision; Pulse contour; Pulse pressure variation; Stroke volume; Stroke volume variation.

Conflict of interest statement

Pr Biais received honoraria from Edwards Lifesciences and Pulsion Medical System as a lecturer. Other authors have no competing interests.

Figures

Fig. 1
Fig. 1
Spaghetti plots: Individual values (solid lines), mean (circle) and standard deviation of stroke volume index (SVI) during the 15 min of recording
Fig. 2
Fig. 2
a Representation of the least significant changes of cardiac index at predefined times: 30 s (s), 45 s, 60 s, 5 min (min), 10 min and 15 min). Individual values (circles) and box plot (lines corresponding to median, upper and lower bars represent 5–95th percentiles). b Representation of the least significant changes of stroke volume index at predefined times: 30 s (s), 45 s, 60 s, 5 min (min), 10 min and 15 min). Individual values (circles) and box plot (lines corresponding to median, upper and lower bars represent 5–95th percentiles). c Representation of the least significant changes of pulse pressure variation at predefined times: 30 s (s), 45 s, 60 s, 5 min (min), 10 min and 15 min). Individual values (circles) and box plot (lines corresponding to median, upper and lower bars represent 5–95th percentiles). d Representation of the least significant changes of stroke volume variation at predefined times: 30 s (s), 45 s, 60 s, 5 min (min), 10 min and 15 min). Individual values (circles) and box plot (lines corresponding to median, upper and lower bars represent 5–95th percentiles)

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Source: PubMed

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