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Sun X, He H, Xu M, Long Y. Peripheral perfusion index of pulse oximetry in adult patients: a narrative review. Eur J Med Res 2024; 29:457. [PMID: 39261939 PMCID: PMC11389527 DOI: 10.1186/s40001-024-02048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 09/02/2024] [Indexed: 09/13/2024] Open
Abstract
The peripheral perfusion index (PI) is derived from pulse oximetry and is defined as the ratio of the pulse wave of the pulsatile portion (arteries) to the non-pulsatile portion (venous and other tissues). A growing number of clinical studies have supported the use of PI in various clinical scenarios, such as guiding hemodynamic management and serving as an indicator of outcome and organ function. In this review, we will introduce and discuss this traditional but neglected indicator of the peripheral microcirculatory perfusion. Further clinical trials are required to clarify the normal and critical values of PI for different monitoring devices in various clinical conditions, to establish different standards of PI-guided strategies, and to determine the effect of PI-guided therapy on outcome.
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Affiliation(s)
- Xiaotong Sun
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Huaiwu He
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China.
| | - Mengru Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yun Long
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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López-Izquierdo R, Zalama-Sánchez D, Rodrigo Enríquez DSG, Ana Ramos R, Laura Fadrique M, Mario Rodil M, Virginia Carbajosa R, Rubén Pérez G, Sanz-García A, Del Pozo Vegas C, Martín-Rodríguez F. Utility of non-invasive monitoring of exhaled carbon dioxide and perfusion index in adult patients in the emergency department. Am J Emerg Med 2024; 79:85-90. [PMID: 38401230 DOI: 10.1016/j.ajem.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Several noninvasive solutions are available for the assessment of patients at risk of deterioration. Capnography, in the form of end-tidal exhaled CO2 (ETCO2) and perfusion index (PI), could provide relevant information about patient prognosis. The aim of the present project was to determine the association of ETCO2 and PI with mortality of patients admitted to the emergency department (ED). METHODS Multicenter, prospective, cohort study of adult patients with acute disease who needed continuous monitoring in the ED. The study included two tertiary hospitals in Spain between October 2022 and June 2023. The primary outcome of the study was in-hospital mortality (all-cause). Demographics, vital signs, ETCO2 and PI were collected. RESULTS A total of 687 patients were included in the study. The in-hospital mortality rate was 6.8%. The median age was 79 years (IQR: 69-86), and 63.3% were males. The median ETCO2 value was 30 mmHg (26-35) in survivors and 23 mmHg (16-30) in nonsurvivors (p = 0.001). For the PI, the medians were 4.7% (2.8-8.1) for survivors and 2.5% (0.98-4-4) for nonsurvivors (p < 0.001). The model that presented the best AUC was age (odds ratio (OR): 1.02 (1.00-1.05)), the respiratory rate (OR: 1.06 (1.02-1.11)), and the PI (OR: 0.83 (0.75-0.91)), with a result of 0.840 (95% CI: 0.795-0.886); the model with the respiratory rate (OR: 1.05 (1.01-1.10)), the PI (OR: 0.84 (0.76-0.93)), and the ETCO2 (no statistically significant OR), with an AUC of 0.838 (95% CI: 0.787-0.889). CONCLUSIONS The present study showed that the PI and respiratory rate are independently associated with in-hospital mortality. Both the PI and ETCO2 are predictive parameters with improved prognostic performance compared with that of standard vital signs.
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Affiliation(s)
- Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | | | | | | | | | - Muñoz Mario Rodil
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | | | - García Rubén Pérez
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain.
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario. Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Av L, Kuzhikkombil Mani S, Ghosh S. Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India. Pediatr Crit Care Med 2024; 25:47-53. [PMID: 37548509 DOI: 10.1097/pcc.0000000000003348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To study in children with septic shock: 1) variation in peripheral perfusion index (PI), which is a derived variable from pulse oximetry; 2) correlation between PI and lactate concentration; and 3) exploratory diagnostic evaluation between mortality and PI. DESIGN Prospective observational study (from October 2018 to March 2020). SETTING Pediatric emergency department and PICU of a tertiary hospital in India. PATIENTS Children (1 mo to 16 yr old) with septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data collected included demographic, clinical, laboratory, and outcome-related variables. Hemodynamic variables like heart rate, mean arterial pressure, and PI, along with serum lactate were recorded at specified intervals. A total of 112 children with septic shock were recruited, with median (interquartile range [IQR]) age of 50 (IQR 12,118.5) months and 65 of 112 (58%) were male children. Overall mortality was 25 of 112 (22%). At admission, the median PI was 0.6 (IQR -0.30, 0.93), and we used PI less than or equal to 0.6 to define a "critical PI." Of 61 children with critical PI at admission, 26 of 61 increased above this threshold by 6 hours. We observed a negative correlation between PI and lactate, at admission ( r = -0.27; 95% CI, -0.44 to -0.08; p = 0.006) and at 6 hours ( r = -0.21; 95% CI, -0.39 to -0.02; p = 0.03). In the exploratory analysis, a PI cutoff of less than or equal to 0.6 at 6 hours had area under the receiver operating curve of 0.74 (95% CI, 0.60-0.88). That is, with a 70% sensitivity and 81% specificity for mortality, the performance of such a test in our population (pre-to-post-test probability) for mortality would be 0.22-0.51. CONCLUSIONS We have used pulse oximetry-derived PI in children presenting with septic shock and found that the value is negatively correlated with a rise in serum lactate concentration. However, the utility of using a critical threshold value in PI (≤ 0.6) after 6 hours of treatment to be indicative of later mortality has considerable uncertainty.
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Affiliation(s)
- Lalitha Av
- Department of Pediatric Critical Care, St Johns Medical College and Hospital, Bengaluru, Karnataka, India
| | - Siji Kuzhikkombil Mani
- Department of Pediatric Critical Care, St Johns Medical College and Hospital, Bengaluru, Karnataka, India
| | - Santu Ghosh
- Department of Biostatistics, St Johns Medical College and Hospital, Bengaluru, Karnataka, India
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Dogan B, Kudu E, Danış F, Ozturk Ince E, Karaca MA, Erbil B. Comparative Analysis of Perfusion Index and End-Tidal Carbon Dioxide in Cardiac Arrest Patients: Implications for Hemodynamic Monitoring and Resuscitation Outcomes. Cureus 2023; 15:e50818. [PMID: 38249229 PMCID: PMC10797221 DOI: 10.7759/cureus.50818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND During cardiopulmonary resuscitation (CPR), some parameters (e.g., intraarterial pressure measurement and end-tidal carbon dioxide (EtCO2)) indicate the quality and outcome of resuscitation. These parameters are generally based on monitoring the hemodynamic status. Perfusion index (PI) is a calculation from the photoplethysmography (PPG) signal and displays the proportion of pulsatile to non-pulsatile light absorption or reflection in the PPG signal. It helps to evaluate cardiac output and tissue perfusion in the care of a critical patient. Its most important advantages are that it can be easily measured with a pulse oximeter probe attached to the finger (non-invasive), can be objectively repeated, can be applied quickly, and is inexpensive. Normal PI values range from 0.2% to 20%. Despite being recognized as a valuable indicator of hemodynamics, there is limited information regarding its relevance in patients experiencing cardiac arrest. Although the PI is known to be a valuable parameter to indicate hemodynamics, information about its value in cardiac arrest patients is limited. This study aims to evaluate the performance of PI and EtCO2 in predicting the return of spontaneous circulation (ROSC) among cardiac arrest patients. METHODS This was a single-center, prospective, observational clinical study including both out-of-hospital and in-hospital adult cardiac arrest patients. The study was conducted from November 1, 2018 to April 30, 2019 at the Emergency Department (ED) of the Hacettepe University Hospital, Ankara, Turkey. The EtCO2 values of the patients were recorded at the time they were intubated (t0) and every five minutes (t5, t10, t15...) during CPR. Along with these measurements, PI values were measured with the Masimo Signal Extraction Technology device (Masimo, California, United States). The study's primary outcome was PI's performance in predicting the ROSC among cardiac arrest patients. The secondary outcomes of the study were the performance of EtCO2 in predicting the ROSC among cardiac arrest patients and the association between PI and EtCO2 values. RESULTS We included a total of 100 cases. The mean age of patients was 70.4 ± 13.4 years, and 65% were male. The ROSC was achieved in 29 patients. There was no statistical difference in PI values between the ROSC (+) and ROSC (-) groups at any minute. However, in the ROSC (+) group, EtCO2 values were observed to be high starting from the fifth minute (t5, p=0.010; t10, p<0.001; t15, p=0.014; t20, p=0.033; t25, p=0.003, respectively). There was no correlation between the PI and EtCO2 values at 0, 5, 10, 15, 20, and 25 minutes (t0, p=0.436; t5, p=0.154; t10, p=0.557; t15, p=0.740; t20 p=0.241; t25 p=0.201, respectively). CONCLUSION Measuring PI values during resuscitation in intubated cardiac arrest patients does not help clinicians predict the outcome. In addition, no correlation was found with EtCO2 values. However, EtCO2 values remained high in patients with the ROSC from the fifth minute onward. Further larger-scale studies are needed regarding the optimal use of PI in cardiac arrest patients.
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Affiliation(s)
- Baki Dogan
- Emergency Medicine, Medical Point Gaziantep Hospital, Gaziantep, TUR
| | - Emre Kudu
- Emergency Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, TUR
| | - Faruk Danış
- Emergency Medicine, Bolu Izzet Baysal Training and Research Hospital, Bolu, TUR
| | | | - Mehmet A Karaca
- Emergency Medicine, Hacettepe University Hospital, Ankara, TUR
| | - Bulent Erbil
- Emergency Medicine, Hacettepe University Hospital, Ankara, TUR
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Saini SS, Shrivastav AK, Sundaram V, Dutta S, Kumar P. Role of perfusion index and plethysmography variability index for predicting outcomes in neonatal sepsis. Acta Paediatr 2023; 112:1884-1891. [PMID: 37222339 DOI: 10.1111/apa.16856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 05/25/2023]
Abstract
AIM (i) To compare perfusion index (PI) and plethysmography variability index (PVI) between neonates with proven or probable sepsis versus no-sepsis, (ii) to examine an association of PI and PVI with in-hospital mortality. METHODS We enrolled neonates with clinically presumed sepsis. Culture-proven or probable sepsis were categorised as 'cases' and no-sepsis as 'controls'. PI and PVI were recorded hourly for 120 h and averaged in 20-time epochs (0-6 h to 115-120 h). RESULTS We analysed 148 neonates with sepsis (proven sepsis = 77, probable sepsis = 71) and 126 with no-sepsis. Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values. Among 148 neonates with sepsis, 43 (29%) died. Non-survivors had significantly lower PI values than survivors (mean difference 0.21 [95% CI 0.14-0.29], p-value <0.001). PI had a significant but modest discriminative ability to identify non-survivors. However, PI did not independently predict mortality. CONCLUSION Neonates with proven/probable sepsis and no-sepsis had comparable PI and PVI values in the first 120 h of sepsis. PI but not PVI values were significantly lower in non-survivors than survivors. PI did not independently predict in-hospital mortality. Due to modest discriminative ability, PI should be interpreted along with other vital signs to take clinical decisions.
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Affiliation(s)
- Shiv Sajan Saini
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar Shrivastav
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gentile FR, Baldi E, Klersy C, Schnaubelt S, Caputo ML, Clodi C, Bruno J, Compagnoni S, Fasolino A, Benvenuti C, Domanovits H, Burkart R, Primi R, Ruzicka G, Holzer M, Auricchio A, Savastano S. Association Between Postresuscitation 12-Lead ECG Features and Early Mortality After Out-of-Hospital Cardiac Arrest: A Post Hoc Subanalysis of the PEACE Study. J Am Heart Assoc 2023; 12:e027923. [PMID: 37183852 PMCID: PMC10227321 DOI: 10.1161/jaha.122.027923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/20/2023] [Indexed: 05/16/2023]
Abstract
Background Once the return of spontaneous circulation after out-of-hospital cardiac arrest is achieved, a 12-lead ECG is strongly recommended to identify candidates for urgent coronary angiography. ECG has no apparent role in mortality risk stratification. We aimed to assess whether ECG features could be associated with 30-day survival in patients with out-of-hospital cardiac arrest. Methods and Results All the post-return of spontaneous circulation ECGs from January 2015 to December 2018 in 3 European centers (Pavia, Lugano, and Vienna) were collected. Prehospital data were collected according to the Utstein style. A total of 370 ECGs were collected: 287 men (77.6%) with a median age of 62 years (interquartile range, 53-70 years). After correction for the return of spontaneous circulation-to-ECG time, age >62 years (hazard ratio [HR], 1.78 [95% CI, 1.21-2.61]; P=0.003), female sex (HR, 1.5 [95% CI, 1.05-2.13]; P=0.025), QRS wider than 120 ms (HR, 1.64 [95% CI, 1.43-1.87]; P<0.001), the presence of a Brugada pattern (HR, 1.49 [95% CI, 1.39-1.59]; P<0.001), and the presence of ST-segment elevation in >1 segment (HR, 1.75 [95% CI, 1.59-1.93]; P<0.001) were independently associated with 30-day mortality. A score ranging from 0 to 26 was created, and by dividing the population into 3 tertiles, 3 classes of risk were found with significantly different survival rate at 30 days (score 0-4, 73%; score 5-7, 66%; score 8-26, 45%). Conclusions The post-return of spontaneous circulation ECG can identify patients who are at high risk of mortality after out-of-hospital cardiac arrest earlier than other forms of prognostication. This provides important risk stratification possibilities in postcardiac arrest care that could help to direct treatments and improve outcomes in patients with out-of-hospital cardiac arrest.
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Affiliation(s)
- Francesca Romana Gentile
- Department of Molecular Medicine, Section of CardiologyUniversity of PaviaPaviaItaly
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Enrico Baldi
- Department of Molecular Medicine, Section of CardiologyUniversity of PaviaPaviaItaly
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Catherine Klersy
- Clinical Epidemiology and BiometryFondazione IRCCS Policlinico San MatteoPaviaItaly
| | | | | | - Christian Clodi
- Department of Emergency MedicineMedical University of ViennaWienAustria
| | | | - Sara Compagnoni
- Department of Molecular Medicine, Section of CardiologyUniversity of PaviaPaviaItaly
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Alessandro Fasolino
- Department of Molecular Medicine, Section of CardiologyUniversity of PaviaPaviaItaly
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | | | - Hans Domanovits
- Clinical Epidemiology and BiometryFondazione IRCCS Policlinico San MatteoPaviaItaly
| | | | - Roberto Primi
- Division of CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Gerhard Ruzicka
- Department of Emergency MedicineMedical University of ViennaWienAustria
| | - Michael Holzer
- Department of Emergency MedicineMedical University of ViennaWienAustria
| | | | - Simone Savastano
- Division of CardiologyFondazione IRCCS Policlinico San MatteoPaviaItaly
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Gulen M, Satar S, Acehan S, Yildiz D, Aslanturkiyeli EF, Aka Satar D, Kucukceylan M. Perfusion index versus visual analogue scale: as an objective tool of renal colic pain in emergency department. Heliyon 2022; 8:e10606. [PMID: 36148281 PMCID: PMC9485029 DOI: 10.1016/j.heliyon.2022.e10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/09/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Perfusion index (PI) has use to monitor sympathetic response changes to pain. In this study, we aimed to evaluate the utility of using perfusion index as an objective marker of pain relief and of the need for rescue analgesia in ED patients with documented renal colic. Methods We conducted a prospective observational study between January 2020 and December 2020. The demographic characteristics of the patients, their complaints, nephrolithiasis histories, vital signs, PI, and VAS scores (on admission and after treatment) were recorded. Results A total of 144 patients were included. All patients were administered 20 mg of Tenoxicam on admission. There was a statistically significant difference between the PI (<0.001) and VAS scores (<0.001) on admission and after the administration of Tenoxicam. 43.1% (n = 62) of the patients needed rescue analgesia. Accordingly to ROC curve, the ability of both PI2 (AUC: 0.615, 95%CI 0.519-0.711, p = 0.018) and ΔPI (AUC: 0.601, 95%CI 0.508-0.694, p = 0.039) indices were determined as statistically significant. The cutoff value of the PI2 level for the prediction of the needed rescue analgesia was 4.65 and the cutoff value for ΔPI (PI2-PI1) was 2. All patients had a pain VAS score of <3 and a mean PI of 5.7 ± 2.9 at discharge from the emergency department. Conclusion In patients presenting to the emergency department with renal colic, the PI value on admission and after analgesic therapy can be helpful in assessing the severity of pain and predict the need for rescue analgesia.
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Affiliation(s)
- Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
- Corresponding author.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Derviş Yildiz
- Iskenderun State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | | | - Deniz Aka Satar
- Adana City Training and Research Hospital, Department of Histology and Embryology and Andrology Laboratory, Adana, Turkey
| | - Melike Kucukceylan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
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Swain SM, Lata M, Kumar S, Mondal S, Behera JK, Mondal H. A Cross-Sectional Study on the Agreement of Perfusion Indexes Measured on Different Fingers by a Portable Pulse Oximeter in Healthy Adults. Cureus 2022; 14:e24853. [PMID: 35702461 PMCID: PMC9176686 DOI: 10.7759/cureus.24853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Pulse oximeters measure oxygen saturation, heart rate, and perfusion index (PI) by analyzing photoplethysmographic signals. PI is an indirect measure of peripheral perfusion expressed as a percentage of pulsatile signals to non-pulsatile signals. PI measured from different sites may show variation. PI may vary when measured on different fingers. In this study, we aimed to observe the variation of PI among different fingers of both hands. Methodology This cross-sectional, observational study was conducted using a convenience sample recruited from a tertiary care hospital in eastern India. PI was measured in apparently healthy adults in a sitting posture after a five-minute rest. The pulse oximeter probe was attached to each finger and readings were taken after one minute. The analysis of variance and intraclass correlation coefficient (ICC) were calculated to compare and find agreement among PI. Results Data from a total of 391 (229 [58.57%] male and 162 [41.43%] female) adult research participants with a mean age of 34.88 ± 10.65 years were analyzed. The PI was the highest on the middle finger in both hands. There was a significant difference among the PI measured on different fingers, F (9, 3900) = 15.49, p <0.0001. The ICC was 0.474, 0.368, and 0.635 for overall, right-hand, and left-hand fingers, respectively, which indicate poor (ICC < 0.5) to moderate (ICC = 0.5-0.75) levels of reliability. Conclusions The PI measured using consumer-grade pulse oximeters on different fingers may provide different readings. The highest PI reading is found on the middle finger. Clinicians and primary care physicians should consider the differences in measured PI among different fingers and should use the readings with caution for any diagnostic purposes.
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Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic Peripheral Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne) 2021; 8:651909. [PMID: 34660615 PMCID: PMC8517109 DOI: 10.3389/fmed.2021.651909] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 09/06/2021] [Indexed: 01/05/2023] Open
Abstract
The plethysmographic peripheral perfusion index (PPI) is a very useful parameter with various emerging utilities in medical practice. The PPI represents the ratio between pulsatile and non-pulsatile portions in peripheral circulation and is mainly affected by two main determinants: cardiac output and balance between sympathetic and parasympathetic nervous systems. The PPI decreases in cases of sympathetic predominance and/or low cardiac output states; therefore, it is a useful predictor of patient outcomes in critical care units. The PPI could be a surrogate for cardiac output in tests for fluid responsiveness, as an objective measure of pain especially in un-cooperative patients, and as a predictor of successful weaning from mechanical ventilation. The PPI is simple to measure, easy to interpret, and has continuously displayed variables, making it a convenient parameter for detecting the adequacy of blood flow and sympathetic-parasympathetic balance.
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Affiliation(s)
- Mamdouh M Elshal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed M Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Reham M Gamal
- Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt
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Compagnoni S, Gentile FR, Baldi E, Contri E, Palo A, Primi R, Currao A, Bendotti S, Ziliani P, Ferrario Ormezzano M, Oltrona Visconti L, Savastano S. Peripheral perfusion index and diagnostic accuracy of the post-ROSC electrocardiogram in patients with medical out-of-hospital cardiac arrest. Resuscitation 2021; 168:19-26. [PMID: 34506876 DOI: 10.1016/j.resuscitation.2021.08.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
AIM A 12-lead electrocardiogram (ECG) after the return of spontaneous circulation (ROSC) is recommended to diagnose a ST-segment elevation myocardial infarction (STEMI). In the early post-ROSC phase, the ECG can show signs of ischemia not necessarily of coronary origin and post-ROSC hypoperfusion could affect ECG reliability. We sought for an association between peripheral perfusion index (PI) values after ROSC and the percentage of false-positive ECG for STEMI. METHODS We considered all the consecutive patients with sustained ROSC after OHCA, admitted to the Fondazione IRCCS Policlinico San Matteo (Pavia) between January 1st, 2015 and December 31st, 2020. ECGs were defined false-positive if meeting the STEMI criteria but without a critical obstructive coronary artery disease worthy of treatment. The mean value of PI over 30 min-monitoring (MPI30) were calculated. RESULTS Among 351 eligible patients post-ROSC ECG, PI monitoring and an invasive coronary angiography (ICA) were available in 84 cases. The rate of false positive was 16/54 (29.6%) and it differed significantly in the three MPI30 tertiles [T1 (0.2-1): 28.6%; T2 (1.1-2.5): 24.1%; T3 (2.6-6.9): 3.7%, p = 0.04; p for trend = 0.02]. Cardiac arrest duration [OR 1.06 (95 %CI 1-1.1), p = 0.007] and MPI30 [T3 vs T1: OR 0.09 (95 %CI 0.01-0.8), p = 0.03] were significantly associated with the probability of acquiring a false-positive ECG. This association was also confirmed when MPI30 was adjusted for cardiac arrest duration [OR 0.2 (95 %CI 0.1-0.6), p=<0.001]. CONCLUSIONS The rate of false-positive ECG for STEMI after ROSC is related with low perfusion. Our results could help to identify the adequate candidates for an immediate ICA.
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Affiliation(s)
- Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Contri
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Ziliani
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | | | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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