Pulse perfusion index for predicting intrapartum fever during epidural analgesia

Sun, Caixia; Ren, Shujun; Chen, Chen; Liu, Qin; Lu, Peichun; Xia, Lin; Shao, Donghua; Xu, Jing

doi:10.1016/j.jclinane.2022.110852

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…Previous research has employed the pulse perfusion index (PI) as an indicator for ERMF. Sun et al found that individuals who developed a fever during labor exhibited signi cantly higher PI values commencing 10 minutes post-ELA, corroborating the time our study detected intergroup disparities 9 .…”

Section: Discussionsupporting

confidence: 90%

“…In clinical practice, direct measurement of SNA is not achievable; instead, we infer its activity through indirect methods. The previous study showed a PI with an AUC of 0.818 for ERMF prediction, higher than our study 9 . This variation may result from different anesthetic concentrations and doses used in the studies.…”

Section: Discussioncontrasting

confidence: 85%

“…Our hypothesis suggests that variations in the degree of sympathetic blockade may be a pathogenic factor contributing to ERMF, prompting us to analyze the correlation between blood ow spectral parameters and the participant's body temperature. Prior research has documented a progressive rise in body temperature during labor, culminating at the termination of the second stage 9,19,20 .We noted a similar gradual increase in blood ow spectral parameters following analgesia. Although our measurements were con ned to a 30-minute post-analgesia window, and we cannot con rm these as peak values, the consistent analgesic level at 30 minutes indicates a relatively stable impact of the local anesthetic on sympathetic tone 9 .…”

Section: Discussionsupporting

confidence: 73%

“…Prior research has documented a progressive rise in body temperature during labor, culminating at the termination of the second stage 9,19,20 .We noted a similar gradual increase in blood ow spectral parameters following analgesia. Although our measurements were con ned to a 30-minute post-analgesia window, and we cannot con rm these as peak values, the consistent analgesic level at 30 minutes indicates a relatively stable impact of the local anesthetic on sympathetic tone 9 . A positive correlation between PSV 30 , EDV 30 , and the peak body temperature during labor supports our initial hypothesis that a more pronounced sympathetic blockade intensi es the disturbance in autonomic function equilibrium and impedes heat dissipation, leading to a higher body temperature increase.…”

Section: Discussionsupporting

confidence: 73%

“…The end-diastolic ow velocity (EDV) was the primary measure of interest. Drawing on previous literature ndings and a pilot study 9 , the anticipated area under the receiver operating characteristic (AUROC) for predicting ERMF was established at 0.8. Given the local ERMF incidence rate of approximately 20% and an estimated attrition rate of 10%, it was calculated that a minimum of 60 participants would be required.…”

Section: Recruitment Of Subjectsmentioning

confidence: 99%

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Regional Blood Flow Spectral Parameters as Predictors of Epidural-Related Maternal Fever: A Prospective Observational Study

Shuai,

Jia,

Lin

et al. 2024

Preprint

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Background Epidural-related maternal fever (ERMF) is a common phenomenon that appears to be unique to laboring women and presents diagnostic and therapeutic dilemmas for anesthesiologists. It is crucial to identify and predict the occurrence of ERMF at an early stage to improve the outcomes for mothers and infants. Method A total of 103 women who had vaginal deliveries with epidural labor analgesia (ELA) were recruited into the study. Pulsed-wave Doppler (PWD) ultrasound was used to measure peak systolic velocity (PSV, cm/s) and end-diastolic velocity (EDV, cm/s) in the regions of the anterior and posterior tibial arteries. Measurements were taken 1 minute before induction of analgesia and at 5-minute intervals for the subsequent 30 minutes. The change of PSV (△PSV) and EDV (△EDV) at 30 minutes relative to baseline after induction of analgesia was calculated. Participants were categorized into two groups based on their body temperature during labor and delivery: febrile and afebrile. The study compared the differences in blood flow spectral parameters between the two groups. Results Of the 103 study participants, 73 were ultimately included for analysis. Thirteen participants (17.8%) in the study developed ERMF. PSV was significantly higher in the febrile group than the non-febrile group at 10 min after ELA (P < 0.05). In contrast, EDV showed a significant difference between the two groups at 15 min after ELA (P < 0.01). Based on linear correlation analysis, there was a positive correlation between PSV and EDV at 30 minutes after analgesia induction and the peak labor temperature (P < 0.001). Receiver operating characteristic (ROC) curve analysis identified a cut-off value of 43.35 and an area under the curve (AUC) of 0.701 for △PSV in the anterior tibial artery region (95% CI 0.525 to 0.878, P = 0.025) and a cut-off value of 29.94 and an AUC of 0.733 for △EDV (95% CI 0.590 to 0.877, P = 0.001). The cut-off value for △PSV in the region of the posterior tibial artery was 39.96 with an AUC of 0.687 (95% CI 0.514 to 0.860, P = 0.034), and the cut-off value for △EDV was 33.10 with an AUC of 0.713 (95% CI 0.558 to 0.869, P = 0.007). Conclusion Regional blood flow spectral parameters after epidural analgesia induction can predict the occurrence of ERMF by indirectly reflecting the degree of sympathetic activity inhibition. Specifically, the amount of change in peak systolic velocity and end-diastolic velocity relative to baseline parameters 30 min after ELA induction was the most predictive. Trial registration The research was conducted in accordance with the Declaration of Helsinki, and approved by the Women and Children’s Hospital, School of Medicine, Xiamen university Ethics Committee. The study has been registered in the Chinese Clinical Trial Registry (reference number: ChiCTR2400080507,31/01/2024).

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 85%

Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 73%

Section: Recruitment Of Subjectsmentioning

confidence: 99%

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Regional Blood Flow Spectral Parameters as Predictors of Epidural-Related Maternal Fever: A Prospective Observational Study

Shuai,

Jia,

Lin

et al. 2024

Preprint

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Predictive value of neutrophil‐to‐lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score‐matched analysis

Li,

Deng,

Sun

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo identify the predictive value of the neutrophil‐to‐lymphocyte ratio (NLR) on admission for intrapartum maternal fever in parturients undergoing epidural analgesia (EA).MethodsIn this retrospective cohort study, propensity score matching (PSM) was applied to address covariates. Univariate and multivariate regression analyses were implemented in sequence to find out the factors influencing intrapartum fever. The receiver operating characteristics curve was applied to determine the area under the curve (AUC) of NLR for intrapartum fever.ResultsNLR and duration of EA were independent risk factors for intrapartum fever. The AUC of the combined indicator (NLR + duration of EA) was higher than that of NLR (AUC = 0.583, 95% confidence interval [CI] 0.53–0.64) and duration of EA (AUC = 0.702, 95% CI 0.66–0.75), reaching 0.715 (95% CI 0.67–0.76; p < 0.001). NLR increased predictive performance for intrapartum fever when added to the duration of EA (net reclassification index 0.076, p = 0.022; integrated discrimination improvement 0.020, p = 0.002).ConclusionNLR has limited predictive power for intrapartum fever. The combination of NLR and duration of epidural analgesia may be considered a promising predictor for intrapartum maternal fever in parturients undergoing epidural analgesia.SynopsisThe neutrophil‐to‐lymphocyte ratio is an accessible predictor for the early identification of parturients at risk of intrapartum fever.

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Development and validation of a prediction model for intrapartum fever related to chorioamnionitis in parturients undergoing epidural analgesia

Ling,

Liu,

et al. 2024

Sci Rep

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Intrapartum fever is a common complication in parturients undergoing epidural analgesia (EA), significantly increasing the incidence of maternal and infant complications. This study aims to develop and validate a prediction model for intrapartum fever related to chorioamnionitis (IFTC) in parturients undergoing epidural analgesia. A total of 596 parturients with fever (axillary temperature ≥ 38℃) who received EA from January 2020 to December 2023 were included and randomly assigned to the training set ( N = 417) and the validation set ( N = 179) according to the ratio of 7:3. The independent risk factors were screened by univariate and multivariate logistic regression analysis to develop a nomogram model. Decision curve analysis (DCA) was used to evaluate the clinical effectiveness and discrimination of the model; calibration curve was used to assess the accuracy of the model. Maximum temperature, meconium-stained amniotic fluid, C-reactive protein (CRP), gestational age and BMI were independent risk factors for predicting IFTC, and the area under receiver operating characteristic curve (AUC) of the training set and the validation set were 0.744 (0.691–0.796) and 0.793 (0.714–0.872), respectively. The calibration curve showed good consistency between predicted and actual results. DCA curve showed that the model had clinical value throughout a broad threshold probability range. The nomogram prediction model based on CRP, meconium-stained amniotic fluid, maximum temperature, gestational age and BMI has good predictive performance for the risk of IFTC in EA parturients.

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Pulse perfusion index for predicting intrapartum fever during epidural analgesia

Cited by 9 publications

References 29 publications

Regional Blood Flow Spectral Parameters as Predictors of Epidural-Related Maternal Fever: A Prospective Observational Study

Regional Blood Flow Spectral Parameters as Predictors of Epidural-Related Maternal Fever: A Prospective Observational Study

Predictive value of neutrophil‐to‐lymphocyte ratio on admission for intrapartum maternal fever in parturients undergoing epidural analgesia: A retrospective cohort study using propensity score‐matched analysis

Development and validation of a prediction model for intrapartum fever related to chorioamnionitis in parturients undergoing epidural analgesia

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