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

Courson, Hugues de; Ferrer, L.; Cane, Grégoire; Verchère, Eric; Sesay, Musa; Nouette‐Gaulain, Karine; Biais, Matthieu

doi:10.1186/s13613-019-0590-z

Cited by 27 publications

(24 citation statements)

References 27 publications

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“…The beat-to-beat values of stroke volume derived from pulse contour analysis performed by the PiCCO2 device were computerised by using the PiCCOWin 4.0 software (Pulsion Medical Systems, Feldkirchen, Germany). Calibration of pulse contour analysis-derived stroke volume was performed by using transpulmonary thermodilution, with injection of three 15-mL cold saline boluses [ 15 , 16 ]. Through transpulmonary thermodilution, we also measured the cardiac function index (estimation of the left ventricular systolic function) [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock

et al. 2021

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Background Through venous contraction, norepinephrine (NE) increases stressed blood volume and mean systemic pressure (Pms) and exerts a “fluid-like” effect. When both fluid and NE are administered, Pms may not only result from the sum of the effects of both drugs. Indeed, norepinephrine may enhance the effects of volume expansion: because fluid dilutes into a more constricted, smaller, venous network, fluid may increase Pms to a larger extent at a higher than at a lower dose of NE. We tested this hypothesis, by mimicking the effects of fluid by passive leg raising (PLR). Methods In 30 septic shock patients, norepinephrine was decreased to reach a predefined target of mean arterial pressure (65–70 mmHg by default, 80–85 mmHg in previously hypertensive patients). We measured the PLR-induced increase in Pms (heart–lung interactions method) under high and low doses of norepinephrine. Preload responsiveness was defined by a PLR-induced increase in cardiac index ≥ 10%. Results Norepinephrine was decreased from 0.32 [0.18–0.62] to 0.26 [0.13–0.50] µg/kg/min (p < 0.0001). This significantly decreased the mean arterial pressure by 10 [7–20]% and Pms by 9 [4–19]%. The increase in Pms (∆Pms) induced by PLR was 13 [9–19]% at the higher dose of norepinephrine and 11 [6–16]% at the lower dose (p < 0.0001). Pms reached during PLR at the high dose of NE was higher than expected by the sum of Pms at baseline at low dose, ∆Pms induced by changing the norepinephrine dose and ∆Pms induced by PLR at low dose of NE (35.6 [11.2] mmHg vs. 33.6 [10.9] mmHg, respectively, p < 0.01). The number of preload responders was 8 (27%) at the high dose of NE and 15 (50%) at the low dose. Conclusions Norepinephrine enhances the Pms increase induced by PLR. These results suggest that a bolus of fluid of the same volume has a greater haemodynamic effect at a high dose than at a low dose of norepinephrine during septic shock.

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Section: Methodsmentioning

confidence: 99%

Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock

et al. 2021

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“…The minimal change of 5% was chosen, because it corresponds to the best threshold of EEXPO-induced CI changes that detects preload responsiveness [ 14 ]. It is compatible with the least significant change of CI pulse [ 25 ].…”

Section: Methodsmentioning

confidence: 64%

“…When considering only the changes observed during EEXPO (n = 42) at polar plot analysis, after removing from the central exclusion data points for which ΔCI were less than 1.5% [ 25 ], the ability to track ΔCI was higher for CI Starling-8.1 (polar concordance: 83%) than for CI Starling-24.4 (polar concordance: 71%) (Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened

Gavelli

Beurton

Teboul

et al. 2021

Ann. Intensive Care

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Background The end-expiratory occlusion (EEXPO) test detects preload responsiveness, but it is 15 s long and induces small changes in cardiac index (CI). It is doubtful whether the Starling bioreactance device, which averages CI over 24 s and refreshes the displayed value every 4 s (Starling-24.4), can detect the EEXPO-induced changes in CI (ΔCI). Our primary goal was to test whether this Starling device version detects preload responsiveness through EEXPO. We also tested whether shortening the averaging and refresh times to 8 s and one second, respectively, (Starling-8.1) improves the accuracy of the device in detecting preload responsiveness using EEXPO. Methods In 42 mechanically ventilated patients, during a 15-s EEXPO, we measured ∆CI through calibrated pulse contour analysis (CIpulse, PiCCO2 device) and using the Starling device. For the latter, we considered both CIStarling-24.4 from the commercial version and CIStarling-8.1 derived from the raw data. For relative ∆CIStarling-24.4 and ∆CIStarling-8.1 during EEXPO, we calculated the area under the receiver operating characteristic curve (AUROC) to detect preload responsiveness, defined as an increase in CIpulse ≥ 10% during passive leg raising (PLR). For both methods, the correlation coefficient vs. ∆CIpulse was calculated. Results Twenty-six patients were preload responders and sixteen non preload-responders. The AUROC for ∆CIStarling-24.4 was significantly lower compared to ∆CIStarling-8.1 (0.680 ± 0.086 vs. 0.899 ± 0.049, respectively; p = 0.027). A significant correlation was observed between ∆CIStarling-8.1 and ∆CIpulse (r = 0.42; p = 0.009), but not between ∆CIStarling-24.4 and ∆CIpulse. During PLR, both ∆CIStarling-24.4 and ∆CIStarling-8.1 reliably detected preload responsiveness. Conclusions Shortening the averaging and refresh times of the bioreactance signal to 8 s and one second, respectively, increases the reliability of the Starling device in detection of EEXPO-induced ∆CI. Trial registration: No. IDRCB:2018-A02825-50. Registered 13 December 2018.

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“…Unilateral PLR test can only induce small increase in cardiac preload, so the technique used to measure changes in cardiac output must be very precise. Pulsio ex is a new pulse contour assessment device; its accuracy has been tested previously [15]. Bioreactance[16], transthoracic echocardiography [17], and capnography [18], which are used in classic PLR tests, and showed good accuracy in detecting changes in cardiac output, need further test veri cation when used in unilateral PLR test.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cardiac Index Induced by Unilateral Passive Leg Raising: a Novel Way for Assessing Fluid Responsiveness

Zhao

Zhang

Lin

et al. 2021

Preprint

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Background: To evaluate the fluid responsiveness of patients, we examined the change in cardiac index (CI) during a unilateral passive leg raising (PLR) test using the ProAQT/Pulsioflex. In addition, we compared the change of CI triggered by bilateral PLR test and unilateral PLR test, and the ability to estimate volume responsiveness in patients.Methods: This was a prospective, observational study, and we enrolled 40 individuals thought of volume expansion. The data of cardiac index, stroke variation in volume, stroke volume index, along with variation in pulse pressure were obtained with ProAQT/Pulsioflex at a semi-recumbent position, during unilateral PLR, bilateral PLR, as well as after expansion of volume (500 ml saline over 15 min). If CI improved more than 15% to the expansion of volume, patients were defined as responders.Results: We excluded three patients. We found that a unilateral PLR-triggered CI increment ≥7.455% forecasted a fluid-triggered CI increment ≥15% with 77.27% sensitivity and 83.33% specificity. Meanwhile, bilateral PLR-triggered increases in CI ≥9.8% forecasted a fluid-triggered CI increment ≥15% with 95.45% sensitivity and 77.78% specificity. The area under the ROC curves constructed for unilateral and bilateral PLR-triggered changes in CI was not significantly different (p=0.1544).Conclusions: The change of CI induced by unilateral PLR may estimate volume responsiveness in patients.Trial registration: Unilateral passive leg raising test to assess patient volume responsiveness: Single-Center Observational Clinical Study, ChiCTR2100046762. Registered 28 May 2021, https://www.chictr.org.cn/edit.aspx?pid=127104&htm=4

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

Cited by 27 publications

References 27 publications

Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock

Norepinephrine potentiates the efficacy of volume expansion on mean systemic pressure in septic shock

Bioreactance reliably detects preload responsiveness by the end-expiratory occlusion test when averaging and refresh times are shortened

Changes in Cardiac Index Induced by Unilateral Passive Leg Raising: a Novel Way for Assessing Fluid Responsiveness

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