Non-invasive detection of hypovolemia or fluid responsiveness in spontaneously breathing subjects

Éva Zöllei, Viktória Bertalan, Andrea Németh, Péter Csábi, Ildikó László, J. Kaszaki, L. Rudas

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation.Methods: 20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of patterned breathing at 6 and 15/min respiratory rate were performed, and central venous blood gas analysis was done. Data from baseline and those of different LBNP levels were compared by analysis of variance and those of different breathing rates by t-test. Finally, we performed ROC analysis to assess the discriminative values of SV, PP, SVV and PPV.Results: Moderate central hypovolemia induced by LBNP caused significant, clinically relevant falls in PP (p <0.05) and SV and central venous oxygen saturation (ScvO2) (p <0.001). The proportion of perfused vessels (p <0.001) and microvascular flow index decreased (p <0.05). PPV increased (p <0.001), however the magnitude of fluctuations was greater during slow patterned breathing (p <0.001). SVV increased only during slow patterned breathing (p <0.001). ROC analysis confirmed the best predictive value for SV (at 56 ml cut-off AUC 0.97, sensitivity 94%, specificity 95%). Slow patterned breathing improved the discriminative value of SVV (p = 0.0023).Conclusions: Functional hemodynamic monitoring with slow patterned breathing to control spontaneous respiration may be worthy for further study in different populations for the assessment of hypovolemia and the prediction of volume responsiveness.

Original languageEnglish
Article number40
JournalBMC Anesthesiology
Volume13
DOIs
Publication statusPublished - Nov 5 2013

Fingerprint

Hypovolemia
Respiration
Lower Body Negative Pressure
Stroke Volume
Blood Pressure
Hemodynamics
Microcirculation
Lip
ROC Curve
Blood Gas Analysis
Central Venous Pressure
Respiratory Rate
Area Under Curve
Analysis of Variance
Healthy Volunteers
Electrocardiography
Oxygen
Sensitivity and Specificity

Keywords

  • Functional hemodynamic monitoring
  • Hypovolemia
  • Microcirculation
  • Spontaneous breathing

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Non-invasive detection of hypovolemia or fluid responsiveness in spontaneously breathing subjects. / Zöllei, Éva; Bertalan, Viktória; Németh, Andrea; Csábi, Péter; László, Ildikó; Kaszaki, J.; Rudas, L.

In: BMC Anesthesiology, Vol. 13, 40, 05.11.2013.

Research output: Contribution to journalArticle

Zöllei, Éva ; Bertalan, Viktória ; Németh, Andrea ; Csábi, Péter ; László, Ildikó ; Kaszaki, J. ; Rudas, L. / Non-invasive detection of hypovolemia or fluid responsiveness in spontaneously breathing subjects. In: BMC Anesthesiology. 2013 ; Vol. 13.
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abstract = "Background: In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation.Methods: 20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of patterned breathing at 6 and 15/min respiratory rate were performed, and central venous blood gas analysis was done. Data from baseline and those of different LBNP levels were compared by analysis of variance and those of different breathing rates by t-test. Finally, we performed ROC analysis to assess the discriminative values of SV, PP, SVV and PPV.Results: Moderate central hypovolemia induced by LBNP caused significant, clinically relevant falls in PP (p <0.05) and SV and central venous oxygen saturation (ScvO2) (p <0.001). The proportion of perfused vessels (p <0.001) and microvascular flow index decreased (p <0.05). PPV increased (p <0.001), however the magnitude of fluctuations was greater during slow patterned breathing (p <0.001). SVV increased only during slow patterned breathing (p <0.001). ROC analysis confirmed the best predictive value for SV (at 56 ml cut-off AUC 0.97, sensitivity 94{\%}, specificity 95{\%}). Slow patterned breathing improved the discriminative value of SVV (p = 0.0023).Conclusions: Functional hemodynamic monitoring with slow patterned breathing to control spontaneous respiration may be worthy for further study in different populations for the assessment of hypovolemia and the prediction of volume responsiveness.",
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AU - Zöllei, Éva

AU - Bertalan, Viktória

AU - Németh, Andrea

AU - Csábi, Péter

AU - László, Ildikó

AU - Kaszaki, J.

AU - Rudas, L.

PY - 2013/11/5

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N2 - Background: In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation.Methods: 20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of patterned breathing at 6 and 15/min respiratory rate were performed, and central venous blood gas analysis was done. Data from baseline and those of different LBNP levels were compared by analysis of variance and those of different breathing rates by t-test. Finally, we performed ROC analysis to assess the discriminative values of SV, PP, SVV and PPV.Results: Moderate central hypovolemia induced by LBNP caused significant, clinically relevant falls in PP (p <0.05) and SV and central venous oxygen saturation (ScvO2) (p <0.001). The proportion of perfused vessels (p <0.001) and microvascular flow index decreased (p <0.05). PPV increased (p <0.001), however the magnitude of fluctuations was greater during slow patterned breathing (p <0.001). SVV increased only during slow patterned breathing (p <0.001). ROC analysis confirmed the best predictive value for SV (at 56 ml cut-off AUC 0.97, sensitivity 94%, specificity 95%). Slow patterned breathing improved the discriminative value of SVV (p = 0.0023).Conclusions: Functional hemodynamic monitoring with slow patterned breathing to control spontaneous respiration may be worthy for further study in different populations for the assessment of hypovolemia and the prediction of volume responsiveness.

AB - Background: In the assessment of hypovolemia the value of functional hemodynamic monitoring during spontaneous breathing is debated. The aim of our study was to investigate in spontaneously breathing subjects the changes in hemodynamic parameters during graded central hypovolemia and to test whether slow patterned breathing improved the discriminative value of stroke volume (SV), pulse pressure (PP), and their variations (SVV, PPV). In addition, we tested the alterations in labial microcirculation.Methods: 20 healthy volunteers participated in our study. Central hypovolemia was induced by lower body negative pressure (LBNP). Continuous signals of ECG, non-invasive blood pressure and central venous pressure were recorded. During baseline and each stage of LBNP the labial microcirculation was investigated by orthogonal polarization spectral imaging, 3 minute periods of patterned breathing at 6 and 15/min respiratory rate were performed, and central venous blood gas analysis was done. Data from baseline and those of different LBNP levels were compared by analysis of variance and those of different breathing rates by t-test. Finally, we performed ROC analysis to assess the discriminative values of SV, PP, SVV and PPV.Results: Moderate central hypovolemia induced by LBNP caused significant, clinically relevant falls in PP (p <0.05) and SV and central venous oxygen saturation (ScvO2) (p <0.001). The proportion of perfused vessels (p <0.001) and microvascular flow index decreased (p <0.05). PPV increased (p <0.001), however the magnitude of fluctuations was greater during slow patterned breathing (p <0.001). SVV increased only during slow patterned breathing (p <0.001). ROC analysis confirmed the best predictive value for SV (at 56 ml cut-off AUC 0.97, sensitivity 94%, specificity 95%). Slow patterned breathing improved the discriminative value of SVV (p = 0.0023).Conclusions: Functional hemodynamic monitoring with slow patterned breathing to control spontaneous respiration may be worthy for further study in different populations for the assessment of hypovolemia and the prediction of volume responsiveness.

KW - Functional hemodynamic monitoring

KW - Hypovolemia

KW - Microcirculation

KW - Spontaneous breathing

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