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Anesth Analg 2006;103:1182-1188
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000202380.22997.24

TECHNOLOGY, COMPUTING, AND SIMULATION

Variations in Arterial Blood Pressure and Photoplethysmography During Mechanical Ventilation

Giuseppe Natalini, MD, Antonio Rosano, MD, Maria E. Franceschetti, MD, Paola Facchetti, MD, and Achille Bernardini, MD

From the Department of Anesthesia, Intensive Care and Emergency, Poliambulanza Hospítal, Brescí, Italy.

Address correspondence and reprint requests to Giuseppe Natalini, MD, Unita’ di Terapia Intensiva – Intensive Care Unit Poliambulanza Hospital Via Bissolati 57, 25124 Brescia, Italy. Address e-mail to natalini-giuseppe{at}poliambulanza.it.

We analyzed ventilation-induced changes in arterial blood pressure and photoplethysmography from waveforms obtained by monitoring 57 patients in the operating room and intensive care unit. Analysis of systolic and pulse pressure variations during positive pressure ventilation, {Delta}Up, {Delta}Down, and changes in the preejection period on both arterial and photoplethysmographic waveforms were possible in 49 (86%) patients. The pulse pressure variation and preejection period were similar when calculated using both arterial blood pressure and photoplethysmography, whereas the other variables were different. Photoplethysmographic pulse variation >9% identified patients with arterial pulse pressure variation >13% (area under ROC curve = 0.85) or {Delta}Down >5 mm Hg (area under ROC curve = 0.85). In hypotensive patients, photoplethysmographic pulse variation >9% remained the best threshold value (pulse pressure variation >13%: area under ROC curve = 0.90; {Delta}Down >5 mm Hg: area under ROC curve = 0.93) for predicting fluid responsiveness. In conclusion, this study showed that pulse variations observed in the arterial pressure waveform and photoplethysmogram are similiar in response to positive pressure ventilation. Furthermore, photoplethysmographic pulse variation > 9% identifies patients with ventilation-induced arterial blood pressure variation that is likely to respond to fluid administration.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.