The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients

Beurton, Alexandra; Teboul, Jean–Louis; Gavelli, Francesco; Gonzalez, Filipe; Girotto, Valentina; Galarza, Laura; Anguel, Nadia; Richard, Christian; Monnet, Xavier

doi:10.1186/s13054-019-2306-z

Cited by 72 publications

(43 citation statements)

References 37 publications

(52 reference statements)

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“…PPI decreases in hypovolemia [13]; thus, it is considered an indirect index for the adequacy of cardiac output. PPI was recently used as a surrogate of the cardiac output during resuscitation of shocked patients [14]. This relation between the PPI and the cardiac output could explain the change in the PPI during the SBT.…”

Section: Discussionmentioning

confidence: 99%

Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation

Lotfy

Hasanin

Rashad

et al. 2020

J Clin Monit Comput

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We hypothesized that impairment of peripheral perfusion index (PPI) during spontaneous breathing trial (SBT) might be predictive of weaning failure. We included 44 consecutive, adult, patients, who were scheduled for weaning after at least 48 h of invasive mechanical ventilation in this prospective observational study. Weaning failure was defined as failed SBT or reintubation within 48 h of extubation. PPI readings were obtained before initiation of the SBT, and every 5 min till the end of the SBT. PPI ratio was calculated at every time point as: PPI value/ baseline PPI. The primary outcome was the accuracy of PPI ratio at the end of the SBT in detecting failed weaning. Forty-three patients were available for the final analysis. Eighteen patients (42%) were considered failed weaning. PPI ratio was higher in patients with successful weaning compared to patients with failed weaning during the last 15 min of the SBT. PPI ratio at the end of SBT was higher in patients with successful weaning compared to patients with failed weaning. PPI ratio at the end of SBT had good predictive ability for weaning failure {area under receiver operating characteristic curve (95% confidence interval): 0.833(0.688-0.929), cutoff value ≤ 1.41}. The change in PPI during SBT is an independent predictor for re-intubation. PPI could be a useful tool for monitoring the patient response to SBT. Patients with successful weaning showed higher augmentation of PPI during the SBT compared to re-intubated patients. Failure of augmenting the PPI by 41% at the end of SBT could predict re-intubation with negative predictive value of 95%. Clinical trial identifier: NCT03974568. https ://clini caltr ials.gov/ct2/show/NCT03 97456 8?term=ahmed +hasan in&draw=3&rank=17

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Section: Discussionmentioning

confidence: 99%

Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation

Lotfy

Hasanin

Rashad

et al. 2020

J Clin Monit Comput

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“…The number was increased to 40 patients (20 patients per group) to compensate for possible/projected dropouts. We chose 20% mean difference in the PPI during sample size calculation because this relative change was previously reported as an accurate index for increased cardiac output after passive leg raising [11].…”

Section: Discussionmentioning

confidence: 99%

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

et al. 2020

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Background: Deliberate hypotension is used to provide a bloodless field during functional endoscopic sinus surgery; however, the impact of controlled hypotension during anesthesia on peripheral tissue perfusion has not been extensively evaluated. The aim of this study was to compare the impact of nitroglycerin-versus labetalolinduced hypotension on peripheral perfusion. Methods: The present randomized, double-blinded, controlled trial included adult patients undergoing endoscopic sinus surgery. Patients were allocated to one of two groups according to the drug received for induction of deliberate hypotension: nitroglycerin (n = 20) or labetalol (n = 20). Mean arterial pressure was maintained at 55-65 mmHg in both groups. Both study groups were compared according to pulse oximeter-derived peripheral perfusion index (primary outcome), serum lactate level, mean arterial pressure, heart rate, surgical field score, and intraoperative blood loss. Results: Forty patients were included in the final analysis. The nitroglycerin group exhibited a higher peripheral perfusion index at nearly all records (p < 0.0001) and lower postoperative serum lactate levels (1.3 ± 0.2 mmol/L vs. 1.7 ± 0.4 mmol/L; p = 0.001) than the labetalol group. The peripheral perfusion index was higher in the nitroglycerin group than at baseline at most intraoperative readings. The median surgical field score was modestly lower in the labetalol group than in the nitroglycerin group in the first 20 min (2 [interquartile range (IQR) 2-2.5] versus 1.5 [IQR 1-2]; p = 0.001). Both groups demonstrated comparable and acceptable surgical field scores in all subsequent readings. Conclusion: Nitroglycerin-induced deliberate hypotension was accompanied by higher peripheral perfusion index and lower serum lactate levels than labetalol-induced deliberate hypotension during sinus endoscopic surgery.

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“…increase in the perfusion index after passive leg raising test) [20]. The perfusion index had many advantages such as being a real-time, simple, non-invasive measure which does not require expensive disposables nor sophisticated devices [21].…”

Section: Oximetry-derived Perfusion Index (Cut-off Value 9%mentioning

confidence: 99%

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

Hasanin

Mostafa

2020

J Anesth

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Non-protocolized fluid administration in critically ill patients, especially those with acute respiratory distress syndrome (ARDS), is associated with poor outcomes. Therefore, fluid administration in patients with Coronavirus disease (COVID-19) should be properly guided. Choice of an index to guide fluid management during a pandemic with mass patient admissions carries an additional challenge due to the relatively limited resources. An ideal test for assessment of fluid responsiveness during this pandemic should be accurate in ARDS patients, economic, easy to interpret by junior staff, valid in patients in the prone position and performed with minimal contact with the patient to avoid spread of infection. Patients with COVID-19 ARDS are divided into two phenotypes (L phenotype and H phenotype) according to their lung compliance. Selection of the proper index for fluid responsiveness varies according to the patient phenotype. Heart-lung interaction methods can be used only in patients with L phenotype ARDS. Real-time measures, such a pulse pressure variation, are more appropriate for use during this pandemic compared to ultrasound-derived measures, because contamination of the ultrasound machine can spread infection. Preload challenge tests are suitable for use in all COVID-19 patients. Passive leg raising test is relatively better than mini-fluid challenge test, because it can be repeated without overloading the patient with fluids. Trendelenburg maneuver is a suitable alternative to the passive leg raising test in patients with prone position. If a cardiac output monitor was not available, the response to the passive leg raising test could be traced by measurement of the pulse pressure or the perfusion index. Preload modifying maneuvers, such as tidal volume challenge, can also be used in COVID-19 patients, especially if the patient was in the gray zone of other dynamic tests. However, the preload modifying maneuvers were not extensively evaluated outside the operating room. Selection of the proper test would vary according to the level of healthcare in the country and the load of admissions which might be overwhelming. Evaluation of the volume status should be comprehensive; therefore, the presence of signs of volume overload such as lower limb edema, lung edema, and severe hypoxemia should be considered beside the usual indices for fluid responsiveness.

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The effects of passive leg raising may be detected by the plethysmographic oxygen saturation signal in critically ill patients

Cited by 72 publications

References 37 publications

Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation

Peripheral perfusion index as a predictor of failed weaning from mechanical ventilation

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

Evaluation of fluid responsiveness during COVID-19 pandemic: what are the remaining choices?

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