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Impact of Withdrawal of 450 ml of Blood on Respiration-Induced Oscillations of the Ear Plethysmographic Waveform

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Abstract

Objective

It has been widely appreciated that ventilation-induced variations in systolic blood pressure during mechanical ventilation correlate with changes in intravascular volume. The present study assessed whether alterations in volume status likewise can be detected with noninvasive monitoring (ear plethysmograph) in non-intubated subjects (awake volunteers).

Methods

Eight healthy adults were monitored with EKG, noninvasive blood pressure, an unfiltered ear plethysmograph, and a respiratory force transduction belt before (PRE) and after (POST) withdrawal of 450 ml of blood from an antecubital vein. Spectral-domain analysis was used to determine the peak ventilatory frequency and the power of the associated variation in the ear plethysmographic tracing; Interphase differences in the respiration-induced plethysmographic variations were assessed by Wilcoxon signed rank test. In addition, the changes in the ear plethysmographic tracing were compared to changes in heart rate and blood pressure.

Results

There was a significant increase in respiratory-associated oscillations at the respiratory frequency between the PRE and POST phases (p = 0.012). These changes were detected despite lack of changes in heart rate or blood pressure.

Conclusions

Respiration-induced changes of the ear plethysmographic waveform during spontaneous ventilation increase significantly as a consequence of withdrawal of approximately one unit of blood in healthy volunteers.

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References

  1. Bilchick KC, Wise RA. Paradoxical physical findings described by kussmaul: pulsus paradoxus, kussmaul’s sign. Lancet 2002; 359: 1940–2

    Article  PubMed  Google Scholar 

  2. Jardin F, Farcot J, Gueret P, Prost J, Ozier Y, Bourdarias J. Cyclic changes in arterial pulse during respiratory support. Circulation 1983; 68: 266–74

    PubMed  CAS  Google Scholar 

  3. Khan F, Davidson NC, Littleford RC, Litchfield SJ, Struthers AD, Belch JJ. Cutaneous vascular responses to acetylcholine are mediated by a prostanoid-dependent mechanism in man. Vasc Med 1997; 2: 82–6

    CAS  Google Scholar 

  4. Michard F. Changes in arterial pressure during mechanical ventilation. Anesthesiology 2005; 103: 419–28

    Article  PubMed  Google Scholar 

  5. Morgan B, Crawford W, Guntheroth W. The hemodynamic effects of changes in blood volume during intermittent positive-pressure ventilation. Anesthesiology 1969; 30: 297–305

    Article  PubMed  CAS  Google Scholar 

  6. Perel A, Pizov R, Cotev S. Systolic blood pressure variation is a sensitive indicator of hypovolemia in ventilated dogs subjected to graded hemorrhage. Anesthesiology 1987; 67: 498–502

    Article  PubMed  CAS  Google Scholar 

  7. Pizov R, Ya’ari Y, Perel A. Systolic pressure variation is greater during hemorrhage than during sodium nitroprusside-induced hypotension in ventilated dogs. Anesth Analg 1988; 67: 170–4

    Article  PubMed  CAS  Google Scholar 

  8. Szold A, Pizov R, Segal E, Perel A. The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs. Intensive Care Med 1989; 15: 368–71

    Article  PubMed  CAS  Google Scholar 

  9. Pizov R, Segal E, Kaplan L, Floman Y, Perel A. The use of systolic pressure variation in hemodynamic monitoring during deliberate hypotension in spine surgery. J Clin Anesth 1990; 2: 96–100

    Article  PubMed  CAS  Google Scholar 

  10. Connors A, Speroff T, Dawson N. The effectiveness of right heart catheterization in the initial care of critically ill patients. JAMA 1996; 276: 889–97

    Article  PubMed  Google Scholar 

  11. Marik PE. The systolic blood pressure variation as an indicator of pulmonary capillary wedge pressure in ventilated patients. Anaesth Intensive Care 1993; 21: 405–8

    PubMed  CAS  Google Scholar 

  12. Ornstein E, Eidelman LA, Drenger B, Elami A, Pizov R. Systolic pressure variation predicts the response to acute blood loss. J Clin Anesth 1998; 10: 137–40

    Article  PubMed  CAS  Google Scholar 

  13. Perel A. Cardiovascular assessment by pressure waveform analysis. ASA Annual Refresher Course Lecture 1991:264

  14. Preisman S, Kogan S, Berkenstadt H, Perel A. Predicting fluid responsiveness in patients undergoing cardiac surgery: functional haemodynamic parameters including the respiratory systolic variation test and static preload indicators. Br J Anaesth 2005; 95: 746–55

    Article  PubMed  CAS  Google Scholar 

  15. Rooke GA, Schwid HA, Shapira Y. The effect of graded hemorrhage and intravascular volume replacement on systolic pressure variation in humans during mechanical and spontaneous ventilation. Anesth Analg 1995; 80: 925–32

    Article  PubMed  CAS  Google Scholar 

  16. Yamakage M, Itoh T, Iwasaki S, Jeong S-W, Namiki A. Variation of “Pulse amplitude” Measured by a pulse oximeter may help predict intravascular volume Can J Anaesth 2005; 52: 207–8

    PubMed  Google Scholar 

  17. Cohn JN, Pinkerson AL, Tristani FE. Mechanism of pulsus paradoxus in clinical shock. J Clin Invest 1967; 46: 1744–55

    PubMed  CAS  Google Scholar 

  18. Dorlas JC, Nijboer JA. Photo-electric plethysmography as a monitoring device in anaesthesia. Application and interpretation. Br J Anaesth 1985; 57: 524–30

    Article  PubMed  CAS  Google Scholar 

  19. Johansson A, Oberg PA. Estimation of respiratory volumes from the photoplethysmographic signal. Part i: experimental results. Med Biol Eng Comput 1999; 37: 42–7

    Article  PubMed  CAS  Google Scholar 

  20. Lherm T, Chevalier T, Troche G, Souron V, Samaha T, Zazzo J. Correlation between plethysmography curve variation (dpleth), pulmonary capillary wedge pressure (pcwp) in mechanically ventilated patients. Br J Anaesth 1995; Suppl. 1: 41

    Google Scholar 

  21. Partridge BL. Use of pulse oximetry as a noninvasive indicator of intravascular volume status. J Clin Monit 1987; 3: 263–8

    PubMed  CAS  Google Scholar 

  22. Shamir M, Eidelman LA, Floman Y, Kaplan L, Pizov R. Pulse oximetry plethysmographic waveform during changes in blood volume. Br J Anaesth 1999; 82: 178–81

    PubMed  CAS  Google Scholar 

  23. Golparvar M, Naddafnia H, Saghaei M. Evaluating the relationship between arterial blood pressure changes and indices of pulse oximetric plethysmography. Anesth Analg 2002; 95: 1686–90

    Article  PubMed  Google Scholar 

  24. Awad A, Ghobashy MA, Ouda W, Stout RG, Silverman DG, Shelley KH. Different responses of ear and finger pulse oximeter wave form to cold pressor test. Anesth Analg 2001; 92: 1483–6

    Article  PubMed  CAS  Google Scholar 

  25. Hertzman AB. The blood supply of various skin areas as estimated by the photoelectric plethysmograph. Am J Physiol 1938; 124: 328–40

    Google Scholar 

  26. Shelley KH, Jablonka DH, Awad AA, Stout RG, Rezkanna H, Silverman DG. What is the best site for measuring the effect of ventilation on the pulse oximeter waveform? Anesth Analg 2006; 103: 372–7

    Article  PubMed  Google Scholar 

  27. Shelley KH, Awad AA, Stout RG, Silverman DG. The use of joint time frequency analysis to quantify the effect of ventilation on the pulse oximeter waveform. J Clin Monit Comput 2006; 20: 81–7

    Article  PubMed  Google Scholar 

  28. Shelley KH, Tamai D, Jablonka D, Gesquiere M, Stout RG, Silverman DG. The effect of venous pulsation on the forehead pulse oximeter wave form as a possible source of error in spo2 calculation. Anesth Analg 2005; 100: 743–7

    Article  PubMed  Google Scholar 

  29. The acute respiratory distress syndrome network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342: 1301–8

    Google Scholar 

  30. Morelot-Panzini C, Lefort Y, Derenne JP, Similowski T. Simplified method to measure respiratory-related changes in arterial pulse pressure in patients receiving mechanical ventilation. Chest 2003; 124: 665–70

    Article  PubMed  Google Scholar 

  31. Bendjelid K, Suter PM, Romand JA. The respiratory change in preejection period: a new method to predict fluid responsiveness. J Appl Physiol 2004; 96: 337–42

    Article  PubMed  Google Scholar 

  32. Reuter DA, Kirchner A, Felbinger TW, Weis FC, Kilger E, Lamm P, Goetz AE. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med 2003; 31: 1399–404

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208051, New Haven, CT, 06520-8051, USA

    Michael J. Gesquiere MD, Aymen A. Awad MD, David G. Silverman MD, Robert G. Stout MD, Denis H. Jablonka MD, Tyler J. Silverman & Kirk H. Shelley MD, PhD

Authors
  1. Michael J. Gesquiere MD
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  2. Aymen A. Awad MD
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  3. David G. Silverman MD
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  4. Robert G. Stout MD
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  5. Denis H. Jablonka MD
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  6. Tyler J. Silverman
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  7. Kirk H. Shelley MD, PhD
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Corresponding author

Correspondence to Kirk H. Shelley MD, PhD.

Additional information

Funded only with departmental funds.

Presented, in part, at the annual meeting of the American Society of Anesthesiologists, October, 2004.

Implications Statement: Quantification of respiration-induced changes of an ear plethysmographic signal provided an indication of volume loss after withdrawal of 450 ml of blood in healthy, non-intubated volunteers.

Gesquiere MJ, Awad AA, Silverman DG, Stout RG, Jablonka DH, Silverman TJ, Shelley KH. Impact of Withdrawal of 450 ml of Blood on Respiration-Induced Oscillations of the Ear Plethysmographic Waveform.

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Gesquiere, M.J., Awad, A.A., Silverman, D.G. et al. Impact of Withdrawal of 450 ml of Blood on Respiration-Induced Oscillations of the Ear Plethysmographic Waveform. J Clin Monit Comput 21, 277–282 (2007). https://doi.org/10.1007/s10877-007-9085-9

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  • DOI: https://doi.org/10.1007/s10877-007-9085-9

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