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Kaya MG, Demir A, Yilmaz MR, Karaman K. Can peripheral perfusion index predict disease mortality in COVID-19 patients in the emergency department. Heliyon 2024; 10:e35383. [PMID: 39165963 PMCID: PMC11334875 DOI: 10.1016/j.heliyon.2024.e35383] [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] [Received: 07/07/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/22/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pneumonia remains a major public health concern. The prognostic efficacy of Peripheral Perfusion Index (PPI) has been researched in different pathologies such as trauma and sepsis. We hypothesized that PPI may serve as predictor of mortality in hospitalized patients with COVID-19 infection. This study aimed to describe the association between PPI at admission and COVID-19 mortality, a new mortality prediction tool. Methods This retrospective, observational study was conducted at a tertiary care center in Turkey. Adult patients diagnosed with COVID-19 infection were enrolled in this study between Februrary 15, 2022 to April 15, 2023. Patient demographic and clinical data including vital signs, laboratory parameters and PPI on admission were collected from an electronic database. PPI was measured using Philips G30E patient monitor system. The primary outcome was in-hospital mortality. Results In total, 200 patients with COVID-19 infection were included and 42 (21 %) in-hospital deaths were identified. For all parameters of study, age, oxygen saturation, respiratory rate, PPI, urea, creatinine, White Blood Cell (WBC), and High-sensitive cardiac Troponin T (hs-cTnT) values were significantly different between survivors vs non-survivors. hs-cTnT >21,25 pg/mL[HR:2.823 (95 % CI:1.211-6583)], PPI <2,15 [HR:2485 (95 % CI:1.194-5.175)], Oxygen saturation <87 % [HR:2258 (95 % CI:1.191-4.282)], and WBC >9680 x103/ml [HR:2.124 (95 % CI:1.083-4.163)] were independent predictors of in-hospital mortality. Conclusions This study identified the factors affecting in-hospital mortality among COVID-19 patients. Importantly, besides many parameter, PPI at admission was significantly associated with COVID-19 mortality and could be a feasible marker in emergency department to identify high risk patients.
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Affiliation(s)
- Mehmet Gokhan Kaya
- Emergency Medicine Service, Yatagan State Hospital, Yatagan, Mugla, Turkey
| | - Ahmet Demir
- Department of Emergency Medicine, Faculty of Medicine, Mugla Sitki Koçman University, Mugla, Turkey
| | - Mehmet Reha Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Mugla Sitki Koçman University, Mugla, Turkey
| | - Kivanc Karaman
- Department of Emergency Medicine, Faculty of Medicine, Mugla Sitki Koçman University, Mugla, Turkey
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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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Højlund J, Petersen DR, Agerskov M, Foss NB. "The peripheral perfusion index discriminates haemodynamic responses to induction of general anaesthesia". J Clin Monit Comput 2023; 37:1533-1540. [PMID: 37289351 PMCID: PMC10651705 DOI: 10.1007/s10877-023-01035-z] [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: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
Induction of general anaesthesia is often accompanied by hypotension. Standard haemodynamic monitoring during anaesthesia relies on intermittent blood pressure and heart rate. Continuous monitoring systemic blood pressure requires invasive or advanced modalities creating a barrier for obtaining important information of the circulation. The Peripheral Perfusion Index (PPI) is obtained non-invasively and continuously by standard photoplethysmography. We hypothesized that different patterns of changes in systemic haemodynamics during induction of general anaesthesia would be reflected in the PPI. Continuous values of PPI, stroke volume (SV), cardiac output (CO), and mean arterial pressure (MAP) were evaluated in 107 patients by either minimally invasive or non-invasive means in a mixed population of surgical patients. 2 min after induction of general anaesthesia relative changes of SV, CO, and MAP was compared to the relative changes of PPI. After induction total cohort mean(± st.dev.) MAP, SV, and CO decreased to 65(± 16)%, 74(± 18)%, and 63(± 16)% of baseline values. In the 38 patients where PPI decreased MAP was 57(± 14)%, SV was 63(± 18)%, and CO was 55(± 18)% of baseline values 2 min after induction. In the 69 patients where PPI increased the corresponding values were MAP 70(± 15)%, SV 80(± 16)%, and CO 68(± 17)% (all differences: p < 0,001). During induction of general anaesthesia changes in PPI discriminated between the degrees of reduction in blood pressure and algorithm derived cardiac stroke volume and -output. As such, the PPI has potential to be a simple and non-invasive indicator of the degree of post-induction haemodynamic changes.
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Affiliation(s)
- Jakob Højlund
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark.
| | - David René Petersen
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
- Currently Department of Anaesthesiology, CKO, Rigshospitalet, Capital Region, Denmark
| | - Marianne Agerskov
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
| | - Nicolai Bang Foss
- Department of Anaesthesiology, Hvidovre University Hospital, Capital Region, Denmark
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Tulay CM, Gurmen ES. Dyspnea: perfus?on ?ndex and tr?age status. J Clin Monit Comput 2023:10.1007/s10877-023-00995-6. [PMID: 37004661 PMCID: PMC10066968 DOI: 10.1007/s10877-023-00995-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/12/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To determine the relationship between perfusion index and the emergency triage classification in patients admitted to the emergency department with dyspnea. METHODS Adult patients who presented with dyspnea and whose perfusion index values were measured with Masimo Radical-7 device at the time of admission, at the first hour and the second hour of admission were included in the study. The PI and oxygen saturation measured by finger probes were compared and the superiority of their effects on the emergency triage classification was compared. RESULTS For the 0.9 cut- off value of the arrival PI level according to the triage status; sensitivity 79.25%; specificity 78.12%; positive predictive value is 66.7 and negative predictive value is 87.2. A statistically significant correlation was found between the triage status and the 0.9 cut- off value of the admission PI level. We can say that the ODDS rate of red triage is 13.63 times (95% CI: 5.99-31.01) times higher in cases with a PI level of 0.9 and below. In the ROC analysis, the cut-off value of 1.1 and above the admission PI level was determined as the most appropriate point for discharge. CONCLUSION The perfusion index can help to determine the triage classification in emergency departments for dyspnea.
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Affiliation(s)
- Cumhur Murat Tulay
- Thoracic Surgery Department, Manisa Celal Bayar University School of Medicine, Manisa, Turkey
| | - Ekim Saglam Gurmen
- Emergency Department, Manisa Celal Bayar University School of Medicine, Manisa, Turkey.
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Kim D, Kim J, Gil NS, Yoo SY, Kim YR, Ko JS, Kang RA, Lim DH, Shin YH. The utility of the perfusion index as an indicator of anesthetic depth for repeated propofol sedation in children: An observational study. Pediatr Int 2023; 65:e15659. [PMID: 37804009 DOI: 10.1111/ped.15659] [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: 03/26/2023] [Revised: 07/26/2023] [Accepted: 08/18/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Children receiving proton therapy require repeated sedation. In this study, we aimed to investigate the utility of the perfusion index (PI) for evaluating consciousness level during repeated propofol sedation. METHODS In this prospective observational study, children aged from birth to 19 years old scheduled for proton therapy under repeated propofol sedation were enrolled. The primary outcome was the equivalence of PI values 5 min after anesthesia induction on consecutive sedation. Total consumption of propofol during sedation, time to reach the University of Michigan sedation scale (UMSS) score 1 after end of proton therapy, and duration of post-anesthesia care unit (PACU) stay were recorded. RESULTS The PI values measured 5 min after induction of anesthesia were not equivalent to each other in consecutive sedation except for the second versus third (1st vs. 2nd: 97.5% CI: -1.34, 0.91; p = 0.206, 0.034; 2nd vs. 3rd: 97.5% CI: -0.87, 0.94; p = 0.023, 0.036 3rd vs. 4th: 97.5% CI: -2.08, -0.26; p < 0.99, <0.001; 4th vs. 5th: 97.5% CI: 0.21, 2.28; p < 0.001, >0.99; respectively). In consecutive sedation, there was not a significantly different difference in the time to reach UMSS score 1 (p > 0.99, all) for total consumption of propofol, time to reach UMSS score 1 after the end of proton therapy, and duration of PACU stay. CONCLUSIONS During repeated propofol sedation in children, PI was insufficient to be used as an indicator of consciousness level assessment. However, we suggest that the information related to repeated sedation provided by this study may be helpful in clinical practice.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jisu Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam-Su Gil
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Ri Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ryung A Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hee Shin
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Korkut M, Bedel C, Selvi F, Zortuk Ö. Can Peripheral Perfusion Index (PPI) Predict Disease Severity in COVID-19 Patients in the Emergency Department? IBNOSINA JOURNAL OF MEDICINE AND BIOMEDICAL SCIENCES 2022. [DOI: 10.1055/s-0042-1748776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Background Coronavirus disease 2019 (COVID-19) causes significant mortality and morbidity in severe patients.
Objective In this study, we aimed to examine the relationship between COVID-19 disease severity and peripheral perfusion index (PPI).
Patients and Methods This prospective observational study included COVID-19 patients admitted to the tertiary hospital emergency department. Basal clinical and demographic data of the patients and PPI values at the time of admission were recorded. The patients were categorized to severe and nonsevere groups according to clinical severity. The relationship between COVID-19 severity and PPI was examined in comparison with the control group.
Results A total of 324 patients who met the inclusion criteria were analyzed. COVID-19 (+) was detected in 180 of these patients. Ninety-two of the COVID-19 (+) patients were in the severe group, and 88 of them were in the non severe group. Note that 164 COVID-19 (–) patients were in the control group. PPI average was found to be 1.44 ± 1.12 in the severe group, and 3.69 ± 2.51 in the nonsevere group. PPI average was found to be significantly lower in the severe group than the nonsevere group (p< 0.01) As for the nonsevere group and control group, PPI averages were found to be 3.69 ± 2.51 and3.54 ± 2.32, respectively, and a significant difference was determined between the two groups (p< 0.05). PPI COVID-19 severity predicting activity was calculated as area under the curve: 0.833, sensitivity:70.4%, andspecificity:71%(p = 0.025) at 2.2 cutoff value.
Conclusion The results of our study showed that PPI is an easy-to-apply and useful parameter in the emergency department in determining the severity of COVID-19 patients.
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Affiliation(s)
- Mustafa Korkut
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Cihan Bedel
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatih Selvi
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ökkeş Zortuk
- Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
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Coutrot M, Dudoignon E, Joachim J, Gayat E, Vallée F, Dépret F. Perfusion index: Physical principles, physiological meanings and clinical implications in anaesthesia and critical care. Anaesth Crit Care Pain Med 2021; 40:100964. [PMID: 34687923 DOI: 10.1016/j.accpm.2021.100964] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
Photoplethysmography (PPG) has been extensively used for pulse oximetry monitoring in anaesthesia, perioperative and intensive care. However, some components of PPG signal have been employed for other purposes, such as non-invasive haemodynamic monitoring. Perfusion index (PI) is derived from PPG signal and represents the ratio of pulsatile on non-pulsatile light absorbance or reflectance of the PPG signal. PI determinants are complex and interlinked, involving and reflecting the interaction between peripheral and central haemodynamic characteristics, such as vascular tone and stroke volume. Recently, several studies have shed light on the interesting performances of this variable, especially assessing regional or neuraxial block success, and haemodynamic monitoring in anaesthesia, perioperative and intensive care. Nevertheless, no review has yet been published concerning the interest of PI in these fields. In this narrative review will be exposed first the physiological and pathophysiological determinants of PI, and then the mean to measure this value as well as its potential limitations. In the second part, the existing data concerning usefulness of PI in different clinical settings such as operating theatres, intensive care units and emergency departments will be presented and discussed. Finally, the perspectives concerning the use of PI and mentioned aspects that should be explored regarding this tool will be underlined.
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Affiliation(s)
- Maxime Coutrot
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; FHU PROMICE, Paris, France.
| | - Emmanuel Dudoignon
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France.
| | - Jona Joachim
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France
| | - Etienne Gayat
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France
| | - Fabrice Vallée
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France; Inria, France; LMS, Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, France
| | - François Dépret
- AP-HP, GH St-Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, France; UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), France; FHU PROMICE, Paris, France; F-CRIN INICRCT network, Paris, France
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Agerskov M, Thusholdt ANW, Holm-Sørensen H, Wiberg S, Meyhoff CS, Højlund J, Secher NH, Foss NB. Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study. Br J Anaesth 2021; 127:396-404. [PMID: 34226038 PMCID: PMC8451236 DOI: 10.1016/j.bja.2021.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. Methods This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days. Results intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P<0.001), with an association of intraoperative mean PPI ≤0.5 and PPI ≤1.5 with the primary outcome: OR 1.79 (95% CI 1.09–2.91; P=0.02) and OR 1.65 (95% CI 1.20–2.27; P=0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI ≤0.5: OR 1.11 (95% CI 1.05–1.17; P<0.001) and with PPI ≤1.5: OR 1.06 (95% CI 1.02–1.09; P=0.002)). Thirty-day mortality in patients with PPI ≤0.5 was 19% vs 10% for PPI >0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]). Conclusions Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.
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Affiliation(s)
- Marianne Agerskov
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Anna N W Thusholdt
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Holm-Sørensen
- Department of Integrative Physiology, NEXS, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian S Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Højlund
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai B Foss
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Savastano S, Baldi E, Contri E, De Pirro A, Sciutti F, Compagnoni S, Fracchia R, Primi R, Frigerio L, Gentile FR, Visconti LO, Palo A. Post-ROSC peripheral perfusion index discriminates 30-day survival after out-of-hospital cardiac arrest. Intern Emerg Med 2021; 16:455-462. [PMID: 32651939 DOI: 10.1007/s11739-020-02430-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prognostication after an out-of-hospital cardiac arrest (OHCA) remains a challenge. The peripheral-derived perfusion index (PI) is a simple and non-invasive way to assess perfusion. We sought to assess whether the PI was able to discriminate the prognosis of patients resuscitated from an OHCA. METHODS All the reports generated by the manual monitor/defibrillator (Corpuls 3 by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for all the OHCAs who achieved ROSC treated by our Emergency Medical Service from January 2015 to December 2018 were reviewed. The mean PI value of each minute after ROSC was automatically provided by the device and the mean value of 30 min of monitoring (MPI30) was calculated. Pre-hospital data were collected according to the Utstein 2014 recommendations. RESULTS Among 1,909 resuscitation attempts, ROSC was achieved in 346 and it was possible to calculate an MPI30 in 164. MPI30 was higher in the patients who survived at 30 days [1.6 (95% CI 1.2-2.1) vs 1 (95% CI 0.8-1.3), p = 0.0017]. At the multivariable Cox regression model, after correction for shockable rhythm, witnessed status, bystander CPR, age, and blood pressure, MPI30 was found to be an independent predictor of both 30-day mortality [RR 0.83 (95% CI 0.69-0.99), p = 0.036] and 30-day mortality or poor neurologic outcome [RR 0.85 (95% CI 0.72-0.99), p = 0.04]. Overall 30-day survival with good neurologic outcome was significantly different in the three tertiles [T1: 0.1-0.8; T2: 0.9-1.8 and T3: 1.82-7.8, log-rank p = 0.007]. CONCLUSION The post-ROSC peripheral perfusion index was found to be an independent predictor of 30-day mortality or poor neurologic outcome. It could help prognostication in OHCA patients.
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Affiliation(s)
- Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100, 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
- AREU Azienda Regionale Emergenza Urgenza-AAT Pavia C/O Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonella De Pirro
- Department of Clinical and Surgical Science, Diagnostic and Pediatric, University of Pavia, Pavia, Italy
| | - Fabio Sciutti
- Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Rosa Fracchia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Laura Frigerio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | | | | | - Alessandra Palo
- AREU Azienda Regionale Emergenza Urgenza-AAT Pavia C/O Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Boier Tygesen G, Kirkegaard H, Raaber N, Trøllund Rask M, Lisby M. Consensus on predictors of clinical deterioration in emergency departments: A Delphi process study. Acta Anaesthesiol Scand 2021; 65:266-275. [PMID: 32941660 DOI: 10.1111/aas.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 12/21/2022]
Abstract
AIM The study aim was to determine relevance and applicability of generic predictors of clinical deterioration in emergency departments based on consensus among clinicians. METHODS Thirty-three predictors of clinical deterioration identified from literature were assessed in a modified two-stage Delphi-process. Sixty-eight clinicians (physicians and nurses) participated in the first round and 48 in the second round; all treating hospitalized patients in Danish emergency departments, some with pre-hospital experience. The panel rated the predictors for relevance (relevant marker of clinical deterioration) and applicability (change in clinical presentation over time, generic in nature and possible to detect bedside). They rated their level of agreement on a 9-point Likert scale and were also invited to propose additional generic predictors between the rounds. New predictors suggested by more than one clinician were included in the second round along with non-consensus predictors from the first round. Final decisions of non-consensus predictors after second round were made by a research group and an impartial physician. RESULTS The Delphi-process resulted in 19 clinically relevant and applicable predictors based on vital signs and parameters (respiratory rate, saturation, dyspnoea, systolic blood pressure, pulse rate, abnormal electrocardiogram, altered mental state and temperature), biochemical tests (serum c-reactive protein, serum bicarbonate, serum lactate, serum pH, serum potassium, glucose, leucocyte counts and serum haemoglobin), objective clinical observations (skin conditions) and subjective clinical observations (pain reported as new or escalating, and relatives' concerns). CONCLUSION The Delphi-process led to consensus of 19 potential predictors of clinical deterioration widely accepted as relevant and applicable in emergency departments.
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Affiliation(s)
- Gitte Boier Tygesen
- Department of Emergency Medicine Horsens Regional Hospital Horsens Denmark
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
| | - Nikolaj Raaber
- Department of Emergency Medicine Aarhus University Hospital Aarhus Denmark
| | - Mette Trøllund Rask
- The Research Clinic for Functional Disorders and Psychosomatics Aarhus University Hospital Aarhus Denmark
| | - Marianne Lisby
- Research Centre for Emergency Medicine Aarhus University Aarhus Denmark
- Department of Emergency Medicine Aarhus University Hospital Aarhus Denmark
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Daş M, Bardakci O, Siddikoglu D, Akdur G, Yilmaz MC, Akdur O, Beyazit Y. Prognostic performance of peripheral perfusion index and shock index combined with ESI to predict hospital outcome. Am J Emerg Med 2020; 38:2055-2059. [PMID: 33142174 DOI: 10.1016/j.ajem.2020.06.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Peripheral perfusion index (PPI) and shock index (SI) are considered valuable predictors of hospital outcome and mortality in various operative and intensive care settings. In the present study, we evaluated the prognostic capabilities of these parameters for performing emergency department (ED) triage, as represented by the emergency severity index (ESI). METHODS This prospective cross-sectional study included 367 patients aged older than 18 years who visited the ED of a tertiary referral hospital. The ESI triage levels with PPI, SI, and other basic vital sign parameters were recorded for each patient. The hospital outcome of the patients at the end of the ED period, such as discharge, admission to the hospital and death were recorded. RESULTS A total of 367 patients (M/F: 178/189) admitted to the ED were categorized according to ESI and included in the study. A decrease in diastolic BP, SpO2 and PPI increased the likelihood of hospitalization and 30-day mortality. Based on univariate analysis, a significant improvement in performance was found by using age, diastolic BP, mean arterial pressure, SpO2, SI and PPI in terms of predicting high acuity level patients (ESI < 3). In the multivariable analysis only SpO2 and PPI were found to predict ESI < 3 patients. CONCLUSION Peripheral perfusion index and SI as novel triage instruments might provide useful information for predicting hospital admission and mortality in ED patients. The addition of these parameters to existing triage instruments such as ESI could enhance the triage specificity in unselected patients admitted to ED.
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Affiliation(s)
- Murat Daş
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Okan Bardakci
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey.
| | - Duygu Siddikoglu
- Department of Biostatistic, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Gökhan Akdur
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Musa Caner Yilmaz
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Okhan Akdur
- Department of Emergency Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Yavuz Beyazit
- Department of Internal Medicine, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
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Karaman K, Sağlam Gürmen E. The role of peripheral perfusion index in differential diagnosis of cardiac and pulmonary-origin dyspnea in emergency service. HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920944050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Pulmonary and cardiac disorders are diagnosed in most patients presenting to the emergency department with dyspnea. Discrimination of pulmonary and cardiac pathologies from each other and early intervention have vital importance. Various methods have been used for assessment of peripheral perfusion, and the peripheral perfusion index) has gained popularity in recent years. This study aimed to investigate the contribution of peripheral perfusion index to the evaluation process in patients presenting with the complaint of dyspnea and diagnosed with either a pulmonary or cardiac pathology. Materials and Methods: We retrospectively reviewed the charts of patients who presented to emergency department with dyspnea between 1 July 2018 and 1 July 2019. Patients in whom the cause of dsypnea was determined to be a cardiac or pulmonary pathology were included in the study. The age, gender, peripheral perfusion index value at admission, the diagnosis, and the hospitalization status were recorded. Results: One hundred and ninety patients consisting of 106 (55.8%) males and 84 (44.2%) females were included in our study. While a pulmonary pathology was determined in 141 (74.2%) patients and a cardiac pathology in 49 (25.8%) patients, 72 (37.9%) patients were decided to be hospitalized. No difference was determined between patients with pulmonary and cardiac pathologies regarding peripheral perfusion index. When the patients were compared regarding hospitalization status and discharge from the emergency department, no significant difference was found to be present between the groups. Conclusion: Since peripheral perfusion index is a noninvasive, easy-to-perform, rapid, and reproducible test, it has been promising as a prognostic and diagnostic parameter. However, it has been realized that PPI was unsuccessful in the evaluation of patients with dyspnea, in the differential diagnosis of cardiac and pulmonary pathologies and prediction of hospitalization status in the emergency department.
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Affiliation(s)
- Kıvanç Karaman
- Emergency Department, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ekim Sağlam Gürmen
- Emergency Department, Faculty of Medicine, Manisa Celal Bayar University, Manisa, Turkey
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13
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The Effect of Mechanical Ventilation on Peripheral Perfusion Index and Its Association With the Prognosis of Critically Ill Patients. Crit Care Med 2020; 47:685-690. [PMID: 30730443 DOI: 10.1097/ccm.0000000000003661] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study aimed to explore the relationship between the variables of mechanical ventilation and circulatory perfusion and its association with ICU mortality during the first day of mechanical ventilation. DESIGN Retrospective cohort study. SETTING The Department of Critical Care Medicine, Peking Union Medical College Hospital. PATIENTS Patients who have undergone mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS This study used the main clinical data obtained from the real-time bedside messaging systems of mechanically ventilated patients during their first day in the ICU from May 2013 to May 2016, including data on the variables of mechanical ventilation and circulatory perfusion. An analysis was then performed on the association of the above data with the patient's in-ICU mortality. There were 5,103 patients who received mechanical ventilation during this period, and of these, 309 patients died during their ICU treatment. Peak airway pressure, mean airway pressure, respiratory rate, heart rate, mean arterial pressure, FIO2, blood oxygen saturation, PO2, peripheral perfusion index, and lactate level were correlated with patient outcomes. A Cox logistic regression analysis suggested that mean airway pressure and perfusion index were the most independent risk and protective factors, respectively, for patient ICU mortality. The areas under the curve for a poor prognosis for mean airway pressure and perfusion index were 0.799 (95% CI, 0.77-0.829) and 0.759 (95% CI, 0.729-0.789), respectively. Further, mean airway pressure and perfusion index exhibited a causal interaction. The relative excess risk due to interaction was 2.061 (-0.691 to 4.814), the attributable proportion due to interaction was 0.210 (-0.027 to 0.447), and the synergy index was 1.306 (0.930-1.833). CONCLUSIONS A higher mean airway pressure and lower perfusion index provided a worse prognosis in mechanically ventilated patients, and it appears that these two variables have a casual interaction.
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Agerskov M, Thusholdt ANW, Højlund J, Meyhoff CS, Sørensen H, Wiberg S, Secher NH, Bang Foss N. Protocol for a multicentre retrospective observational cohort study in Denmark: association between the intraoperative peripheral perfusion index and postoperative morbidity and mortality in acute non-cardiac surgical patients. BMJ Open 2019; 9:e031249. [PMID: 31753878 PMCID: PMC6886954 DOI: 10.1136/bmjopen-2019-031249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Perioperative haemodynamic instability is associated with postoperative morbidity and mortality. Macrocirculatory parameters, such as arterial blood pressure and cardiac output are associated with poor outcome but may be uncoupled from the microcirculation during sepsis and hypovolaemia and may not be optimal resuscitation parameters. The peripheral perfusion index (PPI) is derived from the pulse oximetry signal. Reduced peripheral perfusion is associated with morbidity in critically ill patients and in patients following acute surgery. We hypothesise that a low intraoperative PPI is independently associated with postoperative complications and mortality. METHODS AND ANALYSIS We plan to conduct a retrospective cohort study in approximately 2300 patients, who underwent acute non-cardiac surgery (1 November 2017 to 31 October 2018) at two Danish University Hospitals. Data will be collected from patient records including patient demographics, comorbidity and intraoperative haemodynamic values with PPI as the primary exposure variable, and postoperative complications and mortality within 30 and 90 days as outcome variables. We primarily assess association between PPI and outcome in multivariate regression models. Second, the predictive value of PPI for outcome, using area under the receiver operating characteristics curve is assessed. ETHICS AND DISSEMINATION Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results published in a peer-reviewed journal. The study is approved by the regional research ethics committee, storage and management of data has been approved by the Regional Data Protection Agency, and access to medical records is approved by the hospital board of directors (ClinicalTrials.gov registration no: NCT03757442).
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Affiliation(s)
- Marianne Agerskov
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Jakob Højlund
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Sørensen
- Department of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Sebastian Wiberg
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Nicolai Bang Foss
- Department of Anaesthesia, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Højlund J, Agerskov M, Clemmesen CG, Hvolris LE, Foss NB. The Peripheral Perfusion Index tracks systemic haemodynamics during general anaesthesia. J Clin Monit Comput 2019; 34:1177-1184. [DOI: 10.1007/s10877-019-00420-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023]
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16
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Hariri G, Joffre J, Leblanc G, Bonsey M, Lavillegrand JR, Urbina T, Guidet B, Maury E, Bakker J, Ait-Oufella H. Narrative review: clinical assessment of peripheral tissue perfusion in septic shock. Ann Intensive Care 2019; 9:37. [PMID: 30868286 PMCID: PMC6419794 DOI: 10.1186/s13613-019-0511-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022] Open
Abstract
Sepsis is one of the main reasons for intensive care unit admission and is responsible for high morbidity and mortality. The usual hemodynamic targets for resuscitation of patients with septic shock use macro-hemodynamic parameters (hearth rate, mean arterial pressure, central venous pressure). However, persistent alterations of microcirculatory blood flow despite restoration of macro-hemodynamic parameters can lead to organ failure. This dissociation between macro- and microcirculatory compartments brings a need to assess end organs tissue perfusion in patients with septic shock. Traditional markers of tissue perfusion may not be readily available (lactate) or may take time to assess (urine output). The skin, an easily accessible organ, allows clinicians to quickly evaluate the peripheral tissue perfusion with noninvasive bedside parameters such as the skin temperatures gradient, the capillary refill time, the extent of mottling and the peripheral perfusion index.
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Affiliation(s)
- Geoffroy Hariri
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Jérémie Joffre
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Guillaume Leblanc
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada.,Population Health and Optimal Health Practices Research Unit (Trauma - Emergency - Critical Care Medicine), Centre de recherche du CHU de Québec - Université Laval, Université Laval, Québec City, QC, Canada
| | - Michael Bonsey
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Jean-Remi Lavillegrand
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
| | - Tomas Urbina
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France
| | - Bertrand Guidet
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, Paris, 75012, France
| | - Eric Maury
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France.,Inserm U1136, Paris, 75012, France
| | - Jan Bakker
- Department Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA.,Department of Pulmonology and Critical Care, New York University Medical Center - Bellevue Hospital, New York, USA.,Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hafid Ait-Oufella
- Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. .,Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France. .,Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France.
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17
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Hariri G, Joffre J, Dumas G, Lavillegrand JR, Bigé N, Baudel JL, Guidet B, Maury E, Ait-Oufella H. Exploration de la perfusion tissulaire microcirculatoire au cours du choc septique. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2018-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Au cours des infections graves, les travaux chez l’animal et chez l’homme ont mis en évidence une altération de la perfusion microcirculatoire à l’origine des défaillances viscérales et potentiellement du décès. La sévérité des anomalies microcirculatoires ainsi que leur persistance sont des facteurs prédictifs de mortalité indépendamment du débit cardiaque ou de la pression artérielle. Il est donc indispensable de développer des outils permettant d’évaluer la perfusion microcirculatoire au lit du malade. De nombreux travaux au cours du sepsis suggèrent que l’analyse de la perfusion cutanée au travers de sa température (et/ou du gradient), du temps de recoloration cutané, de l’étendue des marbrures et de l’indice de perfusion périphérique constitue un outil simple qui permet au réanimateur une évaluation rapide des anomalies microcirculatoires.
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18
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de Souza Kock K, Marques JLB. Use of photoplethysmography to predict mortality in intensive care units. Vasc Health Risk Manag 2018; 14:311-320. [PMID: 30464494 PMCID: PMC6217313 DOI: 10.2147/vhrm.s172643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate and compare the capacity to predict hemodynamic variables obtained with photoplethysmography (PPG) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients hospitalized in the intensive care unit (ICU). MATERIALS AND METHODS A prospective cohort study was conducted in the adult ICU of Hospital Nossa Senhora da Conceição, located in Tubarão, Santa Catarina, Brazil. The data collected included the diagnosis for hospitalization, age, gender, clinical or surgical profile, PPG pulse curve signal, and APACHE II score in the first 24 hours. A bivariate and a multivariate logistic regressions were performed, with death as an outcome. A mortality model using artificial neural networks (ANNs) was proposed. RESULTS A total of 190 individuals were evaluated. Most of them were males (6:5), with a median age of 67 (54-75) years, and the main reasons for hospitalization were cardiovascular and neurological causes; half of them were surgical cases. APACHE II median score was 14 (8-19), with a median length of stay of 6 (3-15) days, and 28.4% of the patients died. The following factors were associated with mortality: age (OR=1.023; 95% CI 1.001-1.044; P=0.039), clinical profile (OR=5.481; 95% CI 2.646-11.354; P<0.001), APACHE II (OR=1.168; 95% CI 1.106-1.234; P<0.001), heart rate in the first 24 hours (OR=1.020; 95% CI 1.001-1.039; P=0.036), and time between the systolic and diastolic peak (∆T) intervals obtained with PPG (OR=0.989; 95% CI 0.979-0.998; P=0.015). Compared with the accuracy (area under the receiver-operating characteristic curve) 0.780 of APACHE II (95% CI 0.711-0.849; P<0.001), the multivariate logistic model showed a larger area of 0.858 (95% CI 0.803-0.914; P<0.001). In the model using ANNs, the accuracy was 0.895 (95% CI 0.851-0.940; P<0.001). CONCLUSION The mortality models using variables obtained with PPG, with the inclusion of epidemiological parameters, are very accurate and, if associated to APACHE II, improve prognostic accuracy. The use of ANN was even more accurate, indicating that this tool is important to help in the clinical judgment of the intensivist.
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Affiliation(s)
- Kelser de Souza Kock
- Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil,
| | - Jefferson Luiz Brum Marques
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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Teixeira LG, Martins LR, Schimites PI, de Oliveira RB, Bonella J, Campos RV, Mangini LT, Gasparotto JC, Soares AV. Peripheral perfusion index does not accurately reflect hypoperfusion in healthy dogs undergoing elective ovariohysterectomy. Vet J 2018; 240:27-30. [PMID: 30268329 DOI: 10.1016/j.tvjl.2018.09.003] [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: 08/10/2017] [Revised: 08/28/2018] [Accepted: 09/02/2018] [Indexed: 11/18/2022]
Abstract
This study evaluated the variability of the peripheral perfusion index (PI) in 22 anaesthetised female dogs undergoing elective ovariohysterectomy and examined the relationship between peripheral PI and heart rate, blood pressure, blood pH, end tidal CO2 (EtCO2), O2 saturation (SpO2), core-peripheral temperature gradient (ΔTc-p), partial pressure of CO2 (PCO2), and concentrations of glucose, cortisol, lactate and bicarbonate (HCO3-). Blood pH, lactate and glucose concentrations were determined 15, 30, 45min into the ovariohysterectomy procedure and after extubation. Cortisol concentrations were assessed before anaesthesia and after extubation. Other variables were recorded at every 5min throughout the ovariohysterectomy procedure. Hyperglycaemia was observed in 59% of bitches during surgery, but serum cortisol concentrations remained unchanged. Most measures of perfusion (ΔTc-p, pH, PCO2, EtCO2, SpO2) and heart rate remained unchanged throughout anaesthesia and did not correlate with peripheral PI. Mean arterial pressure increased during the ovariohysterectomy procedure, while peripheral PI decreased, resulting in negative correlations between these variables at 30 and 45min. Lactate concentrations decreased from baseline to the time of measurement post-extubation. Peripheral PI gradually decreased during the ovariohysterectomy procedure, probably reflecting vasoconstriction induced by nociceptive stimuli. Using lactate concentrations as the reference standard for peripheral perfusion, low peripheral PI in healthy bitches undergoing ovariohysterectomy might not represent peripheral hypoperfusion.
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Affiliation(s)
- L G Teixeira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil.
| | - L R Martins
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - P I Schimites
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R B de Oliveira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J Bonella
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R V Campos
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - L T Mangini
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J C Gasparotto
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - A V Soares
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil; Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
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20
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Agerskov M, Sørensen H, Højlund J, Secher NH, Foss NB. Pre-operative haemodynamic monitoring and resuscitation in hip fracture patients: Protocol for a prospective observational study. Acta Anaesthesiol Scand 2018; 62:1314-1320. [PMID: 29851062 DOI: 10.1111/aas.13163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/05/2018] [Accepted: 04/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND In a frail patient group often suffering from dehydration, hip fracture is potentially fatal partly because of the blood loss and thus deteriorated circulation. An important goal for haemodynamic monitoring and resuscitation is early detection of insufficient tissue perfusion. "The peripheral perfusion index" reflects changes in peripheral perfusion and blood volume. We hypothesize that hip fracture patients are hypovolaemic with poor peripheral perfusion and accordingly respond to controlled fluid resuscitation. The peripheral perfusion index might reflect restricted tissue perfusion in spite of stable central haemodynamic variables. METHODS This prospective observational study assess to what extend hip fracture patients suffer from hypovolaemia and respond to a stroke volume-guided fluid challenge. The secondary objectives are to evaluate correlation between the non-invasive peripheral perfusion index and minimally invasive measures of stroke volume, changes in blood volume and near-infrared spectroscopy determined tissue- and cerebral oxygenation and to compare results to prevalence of post-operative complications including mortality. We will include 50 patients (>65 years) presenting a hip fracture and treated in a multimodal fast-track regimen when written informed consent is available. DISCUSSION This is likely the first study to address pre-operative haemodynamic monitoring and resuscitation in hip fracture patients where adequate resuscitation is easily missed. We aim to evaluate feasibility of pre-operative stroke volume-guided haemodynamic optimization in the context of minimally- and non-invasive monitoring of peripheral perfusion and measure of blood volume.
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Affiliation(s)
- M. Agerskov
- Department of Anaesthesiology; Hvidovre Hospital; University of Copenhagen; Hvidovre Denmark
| | - H. Sørensen
- Department of Anaesthesiology; Abdominal Centre; Rigshospitalet; University of Copenhagen; Kobenhavn Denmark
| | - J. Højlund
- Department of Anaesthesiology; Hvidovre Hospital; University of Copenhagen; Hvidovre Denmark
| | - N. H. Secher
- Department of Anaesthesiology; Abdominal Centre; Rigshospitalet; University of Copenhagen; Kobenhavn Denmark
| | - N. B. Foss
- Department of Anaesthesiology; Hvidovre Hospital; University of Copenhagen; Hvidovre Denmark
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21
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Alternatives to the Swan–Ganz catheter. Intensive Care Med 2018; 44:730-741. [DOI: 10.1007/s00134-018-5187-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
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