Is Respiration-Induced Variation in the Photoplethysmogram Associated with Major Hypovolemia in Patients with Acute Traumatic Injuries?
| Autor: | Andrei V. Gribok, Andrew T. Reisner, Jaques Reifman, Liangyou Chen |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Emergency Medical Services medicine.medical_specialty Adolescent Hypovolemia Vital signs Hemorrhage Critical Care and Intensive Care Medicine Young Adult Interquartile range Internal medicine Photoplethysmogram medicine Humans Photoplethysmography Aged Retrospective Studies Receiver operating characteristic Vital Signs business.industry Respiration Shock Retrospective cohort study Middle Aged Respiration Artificial Confidence interval Surgery ROC Curve Area Under Curve Acute Disease Emergency Medicine Cardiology Breathing Wounds and Injuries Female medicine.symptom business Algorithms |
| Zdroj: | Shock. 34:455-460 |
| ISSN: | 1073-2322 |
| DOI: | 10.1097/shk.0b013e3181dc07da |
| Popis: | It has been widely accepted that metrics related to respiration-induced waveform variation (RIWV) of the photoplethysmogram (PPG) have been associated with hypovolemia in mechanically ventilated patients and in controlled laboratory environments. In this retrospective study, we investigated if PPG RIWV metrics have diagnostic value for patients with acute hemorrhagic hypovolemia in the prehospital environment. Photoplethysmogram waveforms and basic vital signs were recorded in trauma patients during prehospital transport. Retrospectively, we used automated algorithms to select patient records with all five basic vital signs and 45 s or longer continuous, clean PPG segments. From these segments, we identified the onset and peak of individual heartbeats and computed waveform variations in the beats' peaks and amplitudes: (1) as the range between the maximum and the minimum (max-min) values and (2) as their interquartile range (IQR). We evaluated their receiver operating characteristic (ROC) curves for major hemorrhage. Separately, we tested whether RIWV metrics have potential independent information beyond basic vital signs by applying multivariate regression. In 344 patients, RIWV max-min yielded areas under the ROC curves (AUCs) not significantly better than a random AUC of 0.50. Respiration-induced waveform variation computed as IQR yielded ROC AUCs of 0.65 (95% confidence interval, 0.54Y0.76) and of 0.64 (0.51Y0.75), for peak and amplitude measures, respectively. The IQR metrics added independent information to basic vital signs (P smaller than 0.05), but only moderately improved the overall AUC. Photoplethysmogram RIWV measured as IQR is preferable over max-min, and using PPG RIWV may enhance physiologic monitoring of spontaneously breathing patients outside strictly controlled laboratory environments. |
| Databáze: | OpenAIRE |
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