Pleth Variability Index to Assess Course of Illness in Children with Asthma

Uong, Audrey; Brandwein, Ariel; Crilly, Colin; York, Tamar; Avarello, Jahn T.; Gangadharan, Sandeep

doi:10.1016/j.jemermed.2018.04.058

Cited by 4 publications

(3 citation statements)

References 10 publications

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“…Krishnan et al 23 recently reported that "visually detected pulsus paradoxus" on the pleth trace at presentation to the emergency department had higher relative risks of adverse outcomes, although the authors' definition of "pulsus paradoxus" was unclear 24 . Previous studies examining pulsus paradoxus-related phenomena from the pleth trace in acute wheeze have shown some association with lung function 25 26 , but no clear correlation with clinical outcome 27 . We observed that RMP was most evident in periods of regular respiration which suggests that respiratory pattern should be considered when making such assessments.…”

Section: Discussionmentioning

confidence: 96%

Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze

et al. 2022

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ObjectiveThere is a lack of objective measures to assess children with acute wheezing episodes. Increased respiratory rate (RR) and pulsus paradoxus (PP) are recognised markers, but poorly recorded in practice. We examined whether they can be reliably assessed from a pulse oximeter plethysmogram (‘pleth’) trace and predict clinical outcome.Patients and methodsWe studied 44 children aged 1–7 years attending hospital with acute wheeze, following initial ‘burst’ bronchodilator therapy (BT), and used custom software to measure RR and assess PP from oximeter pleth traces. Traces were examined for quality, and the accuracy of the RR measurement was validated against simultaneous respiratory inductive plethysmography (RIP). RR and PP at 1 hour after BT were compared with clinical outcomes.ResultsRR from pleth and RIP showed excellent agreement, with a mean difference (RIP minus pleth) of −0.5 breaths per minute (limits of agreement −3.4 to +2.3). 52% of 1 min epochs contained 10 s or more of pleth artefact. At 1 hour after BT, children who subsequently required intravenous bronchodilators had significantly higher RR (median (IQR) 63 (62–66) vs 43 (37–51) breaths per minute) than those who did not, but their heart rate and oxygen saturation were similar. Children with RR ≥55 per minute spent longer in hospital: median (IQR) 30 (22–45) vs 10 (7–21) hours. All children who subsequently required hospital admission had PP-analogous pleth waveforms 1 hour after BT.ConclusionRR can be reliably measured and PP detected from the pulse oximeter pleth trace in children with acute wheeze and both markers predict clinical outcome.Trial registration numberUKCRN15742.

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Section: Discussionmentioning

confidence: 96%

Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze

et al. 2022

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“…[ 18 ] Besides, PVI is known as a parameter indirectly related to the pulsus paradoxus, and it has also been suggested that tachypnea may affect the measurement. [ 19 ] Furthermore, it has been reported in the literature that hypercapnia causes a decrease in PVI, so respiratory rate is considered to be important in the accuracy of PVI measurement. [ 20 ] Conflicting data on PVI measurements during spontaneous breathing have been attributed to all these factors.…”

Section: Discussionmentioning

confidence: 99%

Assessment of pleth variability index in volume changes during ultrafiltration process

Dağar¹,

Uzunosmanoğlu²

2021

Turk J Emerg Med

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OBJECTIVES: Pleth variability index (PVI) has been studied mostly in mechanically ventilated patients, and the role of PVI in predicting volume status and volume changes among spontaneously breathing patients is not clear in the literature. We hypothesized that hemodialysis (HD) can be a valid model for a simulation that can be evaluated the correlation of PVI with fluid changes in various volume states. The aim of this study was to investigate the utility of PVI for assessing volume changes in HD patients who are breathing spontaneously. METHODS: This prospective, observational study included patients aged 18 years or older who had end-stage renal failure and presented for routine HD between December 2019 and January 2020. PVI values were measured before and after HD session. Changes in PVI levels were compared according to the amount of ultrafiltration. RESULTS: A total of sixty patients were included. Mean PVI level before HD (20.7% ± 5%) showed a statistically significant increase to 27.7% ± 6% after HD session ( P < 0.001). According to the amount of fluid removed during HD, the changes in PVI were statistically significant ( P = 0.015). There was a strong correlation between ΔPVI and ultrafiltrated volume ( r = 0.744, P < 0.001). CONCLUSION: The fluid removed by HD caused increase in PVI, and the increase was strongly correlated with the amount of volume change. Bedside monitoring of PVI may provide the clinicians with useful information for monitoring the volume status in critically ill patients with spontaneous breathing.

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“…Future research on these studies can enhance the understanding of these parameters, the monitoring domains, and the relations to clinical asthma outcomes. On the other hand, some hospital-based studies may provide new diagnostic opportunities such as bioimpedance [412], airway resistance during tidal breathing [413], forced oscillation technique [414], exhaled breath profiles and temperatures [415], diaphragm electromyography [416], and plethysmography variability [417][418][419]. Future research is needed to specifically review which hospital-based monitoring technologies may be beneficial for the home assessment of pediatric asthma.…”

Section: Future Perspectivesmentioning

confidence: 99%

eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review

Kamp¹,

Hengeveld²,

Brusse-Keizer³

et al. 2023

J Med Internet Res

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Background eHealth monitoring technologies offer opportunities to more objectively assess symptoms when they appear in daily life. Asthma is the most common chronic disease in childhood with an episodic course, requiring close follow-up of pediatric asthma control to identify disease deterioration, prevent exacerbations, and enhance quality of life. eHealth technologies in pediatric asthma care show promising results regarding feasibility, acceptability, and asthma-related health outcomes. However, broad systematic evaluations of eHealth technologies in pediatric asthma are lacking. Objective The objective of this scoping review was to identify the types and applications of eHealth technologies for monitoring and treatment in pediatric asthma and explore which monitoring domains show the most relevance or potential for future research. Methods A scoping review was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic and comprehensive search was performed on English papers that investigated the development, validation, or application of eHealth technologies for home monitoring or treatment of pediatric asthma in the following databases: PubMed, Cochrane Library, IEEE, Scopus, CINAHL, PsycINFO, and ACM Digital Library. Two authors independently assessed eligibility and extracted data. Data were presented by a descriptive analysis of characteristics and a narrative report for each eHealth domain. Results The review included 370 manuscripts. The following 10 monitoring domains were identified: air quality, airway inflammation markers, lung function, physical activity, sleep, audiovisual, other physiological measurements, questionnaires, medication monitoring, and digital environment (ie, digital platforms, applications, websites, and software tools to monitor or support monitoring). Rising numbers of studies were seen, and the numbers accelerated in the last few years throughout most domains, especially medication monitoring and digital environment. Limited studies (35/370, 9.5%) of multiparameter monitoring strategies, using three or more domains, were found. The number of monitoring validation studies remained stable, while development and intervention studies increased. Intervention outcomes seemed to indicate the noninferiority and potential superiority of eHealth monitoring in pediatric asthma. Conclusions This systematic scoping review provides a unique overview of eHealth pediatric asthma monitoring studies, and it revealed that eHealth research takes place throughout different monitoring domains using different approaches. The outcomes of the review showed the potency for efficacy of most monitoring domains (especially the domains of medication monitoring, lung function, and digital environment). Future studies could focus on modifying potentially relevant hospital-based diagnostics for the home setting to investigate potential beneficial effects and focus on combining home-monitoring domains to facilitate multiparameter decision-making and personalized clinical decision support.

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Pleth Variability Index to Assess Course of Illness in Children with Asthma

Cited by 4 publications

References 10 publications

Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze

Pulse oximetry respiratory monitoring for assessment of acute childhood wheeze

Assessment of pleth variability index in volume changes during ultrafiltration process

eHealth Technologies for Monitoring Pediatric Asthma at Home: Scoping Review

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