Continuous, Noninvasive Measurement of Pulsus Paradoxus in Patients With Acute Asthma

Wright, Robert O.

doi:10.1001/archpedi.1996.02170340028005

Cited by 23 publications

(13 citation statements)

References 19 publications

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“…This compares favorably with the findings of Wright and colleagues who estimated PP based on change in waveform height and found correlation with %PEF (r = - 0.31)[36]. In our investigation we utilized %FEV 1 , the widely accepted criterion standard of acute asthma severity, in addition to secondary severity measures.…”

Section: Discussionsupporting

confidence: 75%

“…We considered a correlation coefficient of 0.30 or greater to be clinically relevant based on the study of Wright and colleagues in which measurement of PP calculated from change in height of finger arterial pressure monitor waveforms was correlated with %PEF (r = - 0.31)[36]. A sample size of 82 subjects would enable us to detect a correlation coefficient of 0.35 or greater between PEP and %FEV 1 values with 90% (β = .010) power and a two-sided significance level of 0.05 (α = 0.05).…”

Section: Methodsmentioning

confidence: 99%

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Noninvasive assessment of asthma severity using pulse oximeter plethysmograph estimate of pulsus paradoxus physiology

2010

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BackgroundPulsus paradoxus estimated by dynamic change in area under the oximeter plethysmograph waveform (PEP) might provide a measure of acute asthma severity. Our primary objective was to determine how well PEP correlates with forced expiratory volume in 1-second (%FEV1) (criterion validity) and change of %FEV1 (responsiveness) during treatment in pediatric patients with acute asthma exacerbations.MethodsWe prospectively studied subjects 5 to 17 years of age with asthma exacerbations. PEP, %FEV1, airway resistance and accessory muscle use were recorded at baseline and at 2 and 4 hours after initiation of corticosteroid and bronchodilator treatments. Statistical associations were tested with Pearson or Spearman rank correlations, logistic regression using generalized estimating equations, or Wilcoxon rank sum tests.ResultsWe studied 219 subjects (median age 9 years; male 62%; African-American 56%). Correlation of PEP with %FEV1 demonstrated criterion validity (r = - 0.44, 95% confidence interval [CI], - 0.56 to - 0.30) and responsiveness at 2 hours (r = - 0.31, 95% CI, - 0.50 to - 0.09) and 4 hours (r = - 0.38, 95% CI, - 0.62 to - 0.07). PEP also correlated with airway resistance at baseline (r = 0.28 for ages 5 to 10; r = 0.45 for ages 10 to 17), but not with change over time. PEP was associated with accessory muscle use (OR 1.16, 95% CI, 1.11 to 1.21, P < 0.0001).ConclusionsPEP demonstrates criterion validity and responsiveness in correlations with %FEV1. PEP correlates with airway resistance at baseline and is associated with accessory muscle use at baseline and at 2 and 4 hours after initiation of treatment. Incorporation of this technology into contemporary pulse oximeters may provide clinicians improved parameters with which to make clinical assessments of asthma severity and response to treatment, particularly in patients who cannot perform spirometry because of young age or severity of illness. It might also allow for earlier recognition and improved management of other disorders leading to elevated pulsus paradoxus.

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Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

Noninvasive assessment of asthma severity using pulse oximeter plethysmograph estimate of pulsus paradoxus physiology

2010

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“…Agitation or dyspnea along with altered level of consciousness, inability to speak, central cyanosis, diaphoresis, and inability to lie down, especially in older children, should be recognized as severe respiratory compromise [8]. The presence of pulsus paradoxus correlates with the severity of the asthma attack and may be useful in monitoring the severity of illness [9,10]. Highrisk factors for asthma severity and fatality include previous severe sudden deterioration, past PICU admissions and previous respiratory failure with the need for mechanical ventilation.…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of Status Asthmaticus in Children

2010

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Asthma is a common chronic inflammatory disorder of the airways characterized by recurrent wheezing, breathlessness, and coughing. Acute exacerbations of asthma can be life-threatening; annual worldwide estimated mortality is 250,000 and most of these deaths are preventable. While most of the acute exacerbations can be managed successfully in the emergency room, few children have severe exacerbations requiring intensive care. Mainstay of treatment for status asthmaticus are inhaled β2 agonist and anticholinergic agents, oxygen along with corticosteroids. Children who do not respond well to initial treatment require parenteral β2 agonist and magnesium. Rarely, sick children need parenteral aminophylline infusion and mechanical ventilation. Guidelines for diagnosis, treatment, ventilator management and supportive care for status asthmaticus in children are discussed in the protocol.

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“…Other findings indicative of impending respiratory failure include disturbance in level of consciousness, inability to speak, markedly diminished or absent breath sounds, central cyanosis, diaphoresis, and an inability to lie down [20]. The presence of pulsus paradoxus correlates with the severity of the asthma attack and may be useful in following the severity of illness [21,22].…”

Section: Clinical Presentationmentioning

confidence: 99%