This Article Full Text Full Text (PDF) CME: Take the course for this article: Course Title: Ability of a Novel Algorithm for Automatic Estimation of Respiratory Variations in Arterial Pulse Pressure to Assess Fluid Responsiveness in the Operating Room Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Cannesson, M. Articles by Lehot, J.-J. Search for Related Content PubMed PubMed Citation Articles by Cannesson, M. Articles by Lehot, J.-J. Related Collections Physiology Ventilation Monitoring (Non-cardiac) Technology

---

TECHNOLOGY, COMPUTING, AND SIMULATION

The Ability of a Novel Algorithm for Automatic Estimation of the Respiratory Variations in Arterial Pulse Pressure to Monitor Fluid Responsiveness in the Operating Room

Maxime Cannesson, MD^*, Juliette Slieker, MD^*, Olivier Desebbe, MD^*, Christian Bauer, MD^*, Pascal Chiari, MD, PhD^*, Roland Hénaine, MD, and Jean-Jacques Lehot, MD^*

From the Hospices Civils de Lyon, Departments of *Anesthesiology and Intensive Care, Cardiac Surgery, Louis Pradel Hospital, Claude Bernard Lyon 1 university, Lyon, France.

Address correspondence and reprint requests to Maxime Cannesson, Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 Avenue du Doyen Lépine, 69500 Bron, France. Address e-mail to maxime_cannesson{at}hotmail.com.

BACKGROUND: Respiratory variations in arterial pulse pressure (PP_man) are accurate predictors of fluid responsiveness in mechanically ventilated patients. However, they cannot be continuously monitored. In our study, we assessed the clinical utility of a novel algorithm for automatic estimation of PP (PP_auto).

METHODS: We studied 25 patients referred for coronary artery bypass grafting. PP_auto was continuously displayed using a method based on automatic detection algorithms, kernel smoothing, and rank-order filters. All patients were under general anesthesia, mechanical ventilation, and were also monitored with a pulmonary artery catheter. PP_man and PP_auto were recorded simultaneously at eight steps during surgery including before and after intravascular volume expansion (500 mL hetastarch). Responders to volume expansion were defined as patients whose cardiac index increased by more than 15% after volume expansion.

RESULTS: Agreement between PP_man and PP_auto over the 200 pairs of collected data was 0.7% ± 3.4% (mean bias ± sd). Seventeen patients were responders to volume expansion. A threshold PP_man value of 12% allowed discrimination of responders to volume expansion with a sensitivity of 88% and a specificity of 100%. A threshold PP_auto value of 10% allowed discrimination of responders to volume expansion with a sensitivity of 82% and a specificity of 88%.

CONCLUSION: PP_auto is strongly correlated to PP_man is an accurate predictor of fluid responsiveness, and allows continuous monitoring of PP. This novel algorithm has potential clinical applications.

This article has been cited by other articles:

				M. Cannesson, B. Vallet, F. Michard, D. Lahner, E. Fleischmann, H. Hetz, G. Pestel, G. Gouvea, R. Diaz, L. Auler, et al. Pulse pressure variation and stroke volume variation: from flying blind to flying right? Br. J. Anaesth., December 1, 2009; 103(6): 896 - 899. [Full Text] [PDF]

				A. Derichard, E. Robin, B. Tavernier, M. Costecalde, M. Fleyfel, J. Onimus, G. Lebuffe, J.-P. Chambon, and B. Vallet Automated pulse pressure and stroke volume variations from radial artery: evaluation during major abdominal surgery Br. J. Anaesth., November 1, 2009; 103(5): 678 - 684. [Abstract] [Full Text] [PDF]

				G. Pestel, K. Fukui, V. Hartwich, P. M. Schumacher, A. Vogt, L. B. Hiltebrand, A. Kurz, Y. Fujita, D. Inderbitzin, and D. Leibundgut Automatic Algorithm for Monitoring Systolic Pressure Variation and Difference in Pulse Pressure Anesth. Analg., June 1, 2009; 108(6): 1823 - 1829. [Abstract] [Full Text] [PDF]

				J. M. Feldman Is It a Bird? Is It a Plane? The Role of Patient Monitors in Medical Decision Making Anesth. Analg., March 1, 2009; 108(3): 707 - 710. [Full Text] [PDF]

				M. Cannesson, H. Musard, O. Desebbe, C. Boucau, R. Simon, R. Henaine, and J.-J. Lehot The Ability of Stroke Volume Variations Obtained with Vigileo/FloTrac System to Monitor Fluid Responsiveness in Mechanically Ventilated Patients Anesth. Analg., February 1, 2009; 108(2): 513 - 517. [Abstract] [Full Text] [PDF]

				A. Perel Automated Assessment of Fluid Responsiveness in Mechanically Ventilated Patients Anesth. Analg., April 1, 2008; 106(4): 1031 - 1033. [Full Text] [PDF]