Use of Pulse Oximeter Waveform as a Non Invasive Functional Haemodynamic Monitoring Technique

  • M. Cannesson
  • J.-J. Lehot
Conference paper


Recently published studies have shown that intraoperative fluid optimization decreases postoperative morbidity and hospital stay [1]. On the other hand, if inappropriate, volume expansion may have deleterious effects. Therefore, preload dependence and fluid responsiveness assessments are of major importance during surgery. Static indicators of fluid responsiveness such as central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), or left ventricular end diastolic area index (LVEDAI) are invasive or uneasily available and have been shown to be poor predictors of fluid responsiveness [2, 3, 4, 5, 6]. Dynamic indicators, relying on the respiratory variations in stroke volume or its surrogates in mechanically ventilated patients, have been shown to be superior to static indicators for the prediction of fluid responsiveness [2, 3, 4, 5, 6]. However, they are either invasive (respiratory variations in arterial pulse pressure (ΔPP), stroke volume variations) with their associated complications [7, 8], technically challenging (respiratory variations in pulse Doppler aortic flow velocity, inferior vena cava diameter) or not widely available (oesophageal Doppler [9]).


Pulmonary Capillary Wedge Pressure Pulse Oximeter Fluid Responsiveness Stroke Volume Variation Respiratory Variation 
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  1. 1.
    Grocott MPW, Mythen MG, Gan TJ (2005) Perioperative fluid management and clinical outcomes in adults. Anesth Analg 100:1093–1106PubMedCrossRefGoogle Scholar
  2. 2.
    Bendjelid K, Romand JA (2003) Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care. Intensive Care Med 29:352–360PubMedCrossRefGoogle Scholar
  3. 3.
    Cannesson M, Slieker J, Desebbe O et al (2006) Prediction of fluid responsiveness using respiratory variations in left ventricular stroke area by transoesophageal echocardiographic automated border detection in mechanically ventilated patients. Crit Care 10:R171PubMedCrossRefGoogle Scholar
  4. 4.
    Michard F, Boussat S, Chemla D et al (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138PubMedGoogle Scholar
  5. 5.
    Pinsky MR, Teboul JL (2005) Assessment of indices of preload and volume responsiveness. Curr Opin Crit Care 11:235–239PubMedCrossRefGoogle Scholar
  6. 6.
    Tavernier B, Makhotine O, Lebuffe G et al (1998) Systolic pressure variation as a guide to fluid therapy in patients with sepsis-induced hypotension. Anesthesiology 89:1313–1321PubMedCrossRefGoogle Scholar
  7. 7.
    Bedford RF, Wollman H (1973) Complications of percutaneous radial-artery cannulation: an objective prospective study in man. Anesthesiology 38:228–236PubMedCrossRefGoogle Scholar
  8. 8.
    Jones RM, Hill AB, Nahrwold ML, Bolles RE (1981) The effect of method of radial artery cannulation on postcannulation blood flow and thrombus formation. Anesthesiology 55:76–78PubMedCrossRefGoogle Scholar
  9. 9.
    Slama M, Masson H, Teboul JL et al (2004) Monitoring of respiratory variations of aortic blood flow velocity using oesophageal Doppler. Intensive Care Med 30:1182–1187PubMedCrossRefGoogle Scholar
  10. 10.
    Shamir M, Eidelman LA, Floman Y et al (1999) Pulse oximetry plethysmographic waveform during changes in blood volume. Br J Anaesth 82:178–181PubMedGoogle Scholar
  11. 11.
    Cannesson M, Besnard C, Durand PG et al (2005) Relation between respiratory variations in pulse oximetry plethysmographic waveform amplitude and arterial pulse pressure in ventilated patients. Crit Care 9:R562–R568PubMedCrossRefGoogle Scholar
  12. 12.
    Natalini G, Rosano A, Franschetti ME et al (2006) Variations in arterial blood pressure and photoplethysmography during mechanical ventilation. Anesth Analg 103:1182–1188PubMedCrossRefGoogle Scholar
  13. 13.
    Shelley KH, Jablonka DH, Awad AA et al (2006) What is the best site for measuring the effect of ventilation on the pulse oximeter waveform? Anesth Analg 103:372–377, table of contentsPubMedCrossRefGoogle Scholar
  14. 14.
    Cannesson M, Desebbe O, Lehot JJ et al (2007) Fluid responsiveness using non-invasive predictors during major hepatic surgery. Br J Anaesth 98:272–274PubMedCrossRefGoogle Scholar
  15. 15.
    Rex S, Brose S, Metzelder S et al (2004) Prediction of fluid responsiveness in patients during cardiac surgery. Br J Anaesth 93:782–788PubMedCrossRefGoogle Scholar
  16. 16.
    Buhre W, Weyland A, Buhre K et al (2000) Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth 84:354–357PubMedGoogle Scholar
  17. 17.
    Solus-Biguenet H, Fleyfel M, Tavernier B et al (2006) Non-invasive prediction of fluid responsiveness during major hepatic surgery. Br J Anaesth 97:808–816PubMedCrossRefGoogle Scholar
  18. 18.
    Cannesson M, Desebbe O, Lehot JJ (2007) Fluid responsiveness using non-invasive predictors during major hepatic surgery. Br J Anaesth 98:272–273; author reply 273–274PubMedCrossRefGoogle Scholar
  19. 19.
    Cannesson M, Attof Y, Rosamel P et al (2007) Respiratory variations in pulse oximetry plethysmographic waveform amplitude to predict fluid responsiveness in the operating room. Anesthesiology 106:1105–1111PubMedCrossRefGoogle Scholar
  20. 20.
    Feissel M, Teboul JL, Merlani P et al (2007) Plethysmographic dynamic indices predict fluid responsiveness in septic ventilated patients. Intensive Care Med 33:993–999PubMedCrossRefGoogle Scholar
  21. 21.
    Natalini G, Rosano A, Taranto M et al (2006) Arterial versus plethysmographic dynamic indices to test responsiveness for testing fluid administration in hypotensive patients: a clinical trial. Anesth Analg 103:1478–1484PubMedCrossRefGoogle Scholar
  22. 22.
    Cannesson M, Delannoy B, Morand A et al (2007) New algorithm for automatic estimation of the respiratory variations in the pulse oximeter waveform. Anesthesiology A452Google Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • M. Cannesson
    • 1
  • J.-J. Lehot
    • 1
  1. 1.Department of AnaesthesiologyHôpital Louis PradelBronFrance

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