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Respiratory variations in pulse oximeter waveform amplitude are influenced by venous return in mechanically ventilated patients under general anaesthesia

Cannesson, M.*; Desebbe, O.*; Hachemi, M.*; Jacques, D.; Bastien, O.*; Lehot, J.-J*

European Journal of Anaesthesiology (EJA): March 2007 - Volume 24 - Issue 3 - p 245-251
doi: 10.1017/S026502150600161X
Original Article

Background and objectives: Respiratory variations in pulse oximetry plethysmographic waveform amplitude (ΔPOP) are related to respiratory variations in arterial pulse pressure (ΔPP) in the critical care setting. The aims of this study were to test the hypothesis that in mechanically ventilated patients undergoing general anaesthesia, ΔPOP calculation is feasible and can detect changes in preload.

Methods: Twenty-five mechanically ventilated patients were studied immediately after induction of general anaesthesia. Haemodynamic data (mean arterial pressure [MAP], central venous pressure [CVP], ΔPP and ΔPOP) were recorded at baseline, before and after tilting the patient from anti-Trendelenburg to Trendelenburg position in order to induce preload changes.

Results: Change from anti-Trendelenburg to Trendelenburg position induced changes in MAP (58 ± 9 to 67 ± 10 mmHg, P < 0.05), CVP (4 ± 4 to 13 ± 5 mmHg, P < 0.05), ΔPP (14 ± 8 to 7 ± 5%, P < 0.05) and ΔPOP (17 ± 12 to 9 ± 5%, P < 0.05). There was a significant relationship between ΔPOP in anti-Trendelenburg position and percent change in MAP after volume expansion (r = 0.82; P < 0.05).

Conclusions: ΔPOP can be determined in the operating room and is influenced by changes in preload. This new index has potential clinical applications for the prediction of fluid responsiveness.

*Claude Bernard Lyon 1 University, Louis Pradel Hospital, Department of Anaesthesiology and Intensive Care, EA 1896, Lyon, France

Lyon Sud Hospital, Intensive Care Unit, Hospices Civils de Lyon, Lyon, France

Correspondence to: Maxime Cannesson, Service d’Anesthésie Réanimation, Hôpital Cardiologique Louis Pradel, 200 avenue du Doyen Lépine, 69500 Bron, France. E-mail:; Tel: +33 4 72 11 8958; Fax: +33 4 72 35 7314

Accepted for publication 28 July 2006

© 2007 European Society of Anaesthesiology