Continuous peripheral perfusion index in patients admitted to hospital wards – An observational study

Rasmussen, Patrick S; Aasvang, Eske Kvanner; Haahr-Raunkjær, Camilla; Elvekjær, Mikkel; Sørensen, Helge Bjarup Dissing; Meyhoff, Christian S.

doi:10.1111/aas.13711

Cited by 8 publications

(12 citation statements)

References 30 publications

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“…Results are consistent with studies of perioperative PPI, where lower PPI is associated with serious adverse events. 15,32 Sympathetic, and thus vascular tone is a major determinant of PPI. Induction and maintenance of anaesthesia suppress sympathetic tone in a dose-dependent manner facilitating vasoplegia, possibly inducing or increasing preload dependency but also affecting PPI, which reflects the ratio between the pulsatile and non-pulsatile component of the arterial waveform in the observed tissue.…”

Section: Discussionmentioning

confidence: 99%

“…Results are consistent with studies of perioperative PPI, where lower PPI is associated with serious adverse events. 15 , 32 …”

Section: Discussionmentioning

confidence: 99%

“…10 , 11 Reduced peripheral perfusion has been associated with both morbidity and mortality in critically ill patients, patients with septic shock, and after acute or major elective surgery. 12 , 13 , 14 , 15 However, evaluation has only been made in relatively small cohorts of surgical patients and the association of intraoperative PPI with postoperative outcomes is inadequately described. Despite multidisciplinary efforts to improve perioperative care, 16 patients undergoing acute major abdominal or hip fracture surgery continue to demonstrate high rates of postoperative morbidity and mortality.…”

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confidence: 99%

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Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Agerskov¹,

Thusholdt²,

Sørensen³

et al. 2021

British Journal of Anaesthesia

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Background: We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. Methods: This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a ClavieneDindo Class !III or death, within 30 days. Results: intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05e1.19; P<0.001), with an association of intraoperative mean PPI 0.5 and PPI 1.5 with the primary outcome: OR 1.79 (95% CI 1.09e2.91; P¼0.02) and OR 1.65 (95% CI 1.20e2.27; P¼0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI 0.5: OR 1.11 (95% CI 1.05e1.17; P<0.001) and with PPI 1.5: OR 1.06 (95% CI 1.02e1.09; P¼0.002)). Thirty-day mortality in patients with PPI 0.5 was 19% vs 10% for PPI >0.5, P¼0.003. If PPI was 1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP 65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92e1.58; P¼0.2]). Conclusions: Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.

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Section: Discussionmentioning

confidence: 99%

“…Results are consistent with studies of perioperative PPI, where lower PPI is associated with serious adverse events. 15 , 32 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Agerskov¹,

Thusholdt²,

Sørensen³

et al. 2021

British Journal of Anaesthesia

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“…However, standard blood pressure monitors were not continuously measuring (measurements every 30 or 60 min), and with the used devices, it would not be possible to measure continuously due to patient discomfort. This requests novel solutions such as algorithms utilizing information from the ECG and plethysmogram to assess blood pressure, or perfusion index, allowing accurate continuous monitoring of the circulation and thereby the opportunity to dismiss the, for some patients, unpleasant standard equipment 35,36 …”

Section: Discussionmentioning

confidence: 99%

Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients

Haahr-Raunkjær

Mølgaard

Elvekjær

et al. 2022

Acta Anaesthesiol Scand

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Background: Patients undergoing major surgery are at risk of complications, so-called serious adverse events (SAE). Continuous monitoring may detect deteriorating patients by recording abnormal vital signs. We aimed to assess the association between abnormal vital signs inspired by Early Warning Score thresholds and subsequent SAEs in patients undergoing major abdominal surgery.Methods: Prospective observational cohort study continuously monitoring heart rate, respiratory rate, peripheral oxygen saturation, and blood pressure for up to 96 h in 500 postoperative patients admitted to the general ward. Exposure variables were vital sign abnormalities, primary outcome was any serious adverse event occurring within 30 postoperative days. The primary analysis investigated the association between exposure variables per 24 h and subsequent serious adverse events.Results: Serious adverse events occurred in 37% of patients, with 38% occurring during monitoring. Among patients with SAE during monitoring, the median duration of vital sign abnormalities was 272 min (IQR 110-447), compared to 259 min (IQR 153-394) in patients with SAE after monitoring and 261 min (IQR 132-468) in the patients without any SAE (p = .62 for all three group comparisons). Episodes of heart rate ≥110 bpm occurred in 16%, 7.1%, and 3.9% of patients in the time before SAE during monitoring, after monitoring, and without SAE, respectively (p < .002). Patients withThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…It can be easily monitored as noninvasive by pulse oximetry probefrom fingertip, hand, toe, and ear lobe. 11 There are studies in the literature showing that the PPI changes are closely associated with the cardiac output dynamic changes. 12 Therefore, in the cases that cardiac output cannot be monitored, PPI, which can be monitored as noninvasive as a pulse oximetry method, can be a guide in the critical patient care.…”

Section: Introductionmentioning

confidence: 99%

Can Peripheral Perfusion Index (PPI) Predict Disease Severity in COVID-19 Patients in the Emergency Department?

Korkut¹,

Bedel²,

Selvi³

et al. 2022

Ibnosina Journal of Medicine and Biomedical Sciences

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Background Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity in severe patients. Objective In this study, we aimed to examine the relationship between COVID-19 disease severity and peripheral perfusion index (PPI). Patients and Methods This prospective observational study included COVID-19 patients admitted to the tertiary hospital emergency department. Basal clinical and demographic data of the patients and PPI values at the time of admission were recorded. The patients were categorized to severe and nonsevere groups according to clinical severity. The relationship between COVID-19 severity and PPI was examined in comparison with the control group. Results A total of 324 patients who met the inclusion criteria were analyzed. COVID-19 (+) was detected in 180 of these patients. Ninety-two of the COVID-19 (+) patients were in the severe group, and 88 of them were in the non severe group. Note that 164 COVID-19 (–) patients were in the control group. PPI average was found to be 1.44 ± 1.12 in the severe group, and 3.69 ± 2.51 in the nonsevere group. PPI average was found to be significantly lower in the severe group than the nonsevere group (p< 0.01) As for the nonsevere group and control group, PPI averages were found to be 3.69 ± 2.51 and3.54 ± 2.32, respectively, and a significant difference was determined between the two groups (p< 0.05). PPI COVID-19 severity predicting activity was calculated as area under the curve: 0.833, sensitivity:70.4%, andspecificity:71%(p = 0.025) at 2.2 cutoff value. Conclusion The results of our study showed that PPI is an easy-to-apply and useful parameter in the emergency department in determining the severity of COVID-19 patients.

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Continuous peripheral perfusion index in patients admitted to hospital wards – An observational study

Cited by 8 publications

References 30 publications

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Continuous monitoring of vital sign abnormalities; association to clinical complications in 500 postoperative patients

Can Peripheral Perfusion Index (PPI) Predict Disease Severity in COVID-19 Patients in the Emergency Department?

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