Evaluation of least significant changes of pulse contour analysis-derived parameters

Hugues de Courson; Loic Ferrer; Grégoire Cane; Eric Verchère; Musa Sesay; Karine Nouette-Gaulain; Matthieu Biais

doi:10.1186/s13613-019-0590-z

Evaluation of least significant changes of pulse contour analysis-derived parameters

Ann Intensive Care. 2019 Oct 11;9(1):116. doi: 10.1186/s13613-019-0590-z.

Authors

Hugues de Courson¹, Loic Ferrer², Grégoire Cane¹, Eric Verchère¹, Musa Sesay¹, Karine Nouette-Gaulain^{1

3}, Matthieu Biais^{4

5

6}

Affiliations

¹ Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France.
² Biostatistics Unit, Institut Curie, U900, Hôpital René Huguenin Saint-Cloud, Saint-Cloud, France.
³ INSERM, U12-11, Laboratoire de Maladies Rares: Génétique et Métabolisme (MRGM), Univ. Bordeaux, Bordeaux, France.
⁴ Department of Anesthesiology and Critical Care, Pellegrin Bordeaux University Hospital, 33000, Bordeaux, France. [email protected].
⁵ Adaptation cardiovasculaire à l'ischémie, U1034, Univ. Bordeaux, 33600, Pessac, France. [email protected].
⁶ Department of Anaesthesiology and Critical Care Pellegrin, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux Cedex, France. [email protected].

Abstract

Background: Many maneuvers assessing fluid responsiveness (minifluid challenge, lung recruitment maneuver, end-expiratory occlusion test, passive leg raising) are considered as positive when small variations in cardiac index, stroke volume index, stroke volume variation or pulse pressure variation occur. Pulse contour analysis allows continuous and real-time cardiac index, stroke volume, stroke volume variation and pulse pressure variation estimations. To use these maneuvers with pulse contour analysis, the knowledge of the minimal change that needs to be measured by a device to recognize a real change (least significant change) has to be studied. The aim of this study was to evaluate the least significant change of cardiac index, stroke volume index, stroke volume variation and pulse pressure variation obtained using pulse contour analysis (ProAQT^®, Pulsion Medical System, Germany).

Methods: In this observational study, we included 50 mechanically ventilated patients undergoing neurosurgery in the operating room. Cardiac index, stroke volume index, pulse pressure variation and stroke volume variation obtained using ProAQT^® (Pulsion Medical System, Germany) were recorded every 12 s during 15-min steady-state periods. Least significant changes were calculated every minute.

Results: Least significant changes statistically differed over time for cardiac index, stroke volume index, pulse pressure variation and stroke volume variation (p < 0.001). Least significant changes ranged from 1.3 to 0.7% for cardiac index, from 1.3 to 0.8% for stroke volume index, from 10 to 4.9% for pulse pressure variation and from 10.8 to 4.3% for stroke volume variation.

Conclusion: To conclude, the present study suggests that pulse contour analysis is able to detect rapid and small changes in cardiac index and stroke volume index, but the interpretation of rapid and small changes of pulse pressure variation and stroke volume variation must be done with caution.

Keywords: Precision; Pulse contour; Pulse pressure variation; Stroke volume; Stroke volume variation.