Respiratory Variations in Pulse Pressure Reflect Central Hypovolemia during Noninvasive Positive Pressure Ventilation

Ingrid Elise Hoff; Lars Øivind Høiseth; Jonny Hisdal; Jo Røislien; Svein Aslak Landsverk; Knut Arvid Kirkebøen

doi:10.1155/2014/712728

Respiratory Variations in Pulse Pressure Reflect Central Hypovolemia during Noninvasive Positive Pressure Ventilation

Crit Care Res Pract. 2014:2014:712728. doi: 10.1155/2014/712728. Epub 2014 Feb 19.

Authors

Ingrid Elise Hoff¹, Lars Øivind Høiseth², Jonny Hisdal³, Jo Røislien⁴, Svein Aslak Landsverk⁵, Knut Arvid Kirkebøen²

Affiliations

¹ Norwegian Air Ambulance Foundation, Holterveien 24, 1441 Drøbak, Norway ; Department of Anaesthesiology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway.
² Department of Anaesthesiology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway ; Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
³ Department of Vascular Medicine, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway.
⁴ Norwegian Air Ambulance Foundation, Holterveien 24, 1441 Drøbak, Norway ; Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
⁵ Department of Anaesthesiology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424 Oslo, Norway.

Abstract

Background. Correct volume management is essential in patients with respiratory failure. We investigated the ability of respiratory variations in noninvasive pulse pressure (ΔPP), photoplethysmographic waveform amplitude (ΔPOP), and pleth variability index (PVI) to reflect hypovolemia during noninvasive positive pressure ventilation by inducing hypovolemia with progressive lower body negative pressure (LBNP). Methods. Fourteen volunteers underwent LBNP of 0, -20, -40, -60, and -80 mmHg for 4.5 min at each level or until presyncope. The procedure was repeated with noninvasive positive pressure ventilation. We measured stroke volume (suprasternal Doppler), ΔPP (Finapres), ΔPOP, and PVI and assessed their association with LBNP-level using linear mixed model regression analyses. Results. Stroke volume decreased with each pressure level (-11.2 mL, 95% CI -11.8, -9.6, P < 0.001), with an additional effect of noninvasive positive pressure ventilation (-3.0 mL, 95% CI -8.5, -1.3, P = 0.009). ΔPP increased for each LBNP-level (1.2%, 95% CI 0.5, 1.8, P < 0.001) and almost doubled during noninvasive positive pressure ventilation (additional increase 1.0%, 95% CI 0.1, 1.9, P = 0.003). Neither ΔPOP nor PVI was significantly associated with LBNP-level. Conclusions. During noninvasive positive pressure ventilation, preload changes were reflected by ΔPP but not by ΔPOP or PVI. This implies that ΔPP may be used to assess volume status during noninvasive positive pressure ventilation.