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Variations in Pulse Oximetry Plethysmographic Waveform Amplitude and Hemodynamic Assessment Induced by Passive Leg Raising in Spontaneously Breathing Adult Volunteers
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Jai Woog Ko, Sang Weon Chung, Yo Seob Park, Kyo Joon Lee, Dong Seok Moon, In Byung Kim
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Korean J Crit Care Med. 2008;23(1):6-12.
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DOI: https://doi.org/10.4266/kjccm.2008.23.1.6
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 Abstract
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- BACKGROUND
In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsivenss is a difficult challenge. Our objective was to test whether the respiratory changes in pulse oxymetry plethysmographic waveform amplitude (POP) and in stroke volume (deltaSV) could predict fluid responsiveness to passive leg raising (PLR) in normal volunteers.
METHODS
We investigated 25 normal volunteers. We assessed hemodynamic status (HR, SBP, MAP, CI and SVI) and calculated the respiratory variation in pulse oximetry plethysmographic waveform amplitude at supine and after PLR. We attached a pulse oximeter of 25 spontaneously breathing volunteers as several time points: after 1 min and 5 min in supine position and during PLR at 60degrees. Heart rate, non-invasive blood pressures (mean arterial pressure, systolic blood pressure), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP defined as (POPmax-POPmin)/[(POPmax+POPmin)/2] were recorded using monitor.
RESULTS
Comparing to supine and PLR, systolic blood pressure and mean arterial pressure were not different, but the change in cardiac index, stroke volume and respiratory variation in POP were significant different. In response group (> or =10% in deltaCI), the change in cardiac index, stroke volume and respiratory variation in POP were significant greater.
CONCLUSION
PLR induces a significant decrement of variation in POP amplitude among spontaneouely breathing volunteers.
We suppose that the changes in stroke volume and the respiratory variation in pulse oximetry plethysmographic waveform amplitude induced by PLR predict fluid responsiveness in spontaneous breathing patients.
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Factors of Cardiopulmonary Resuscitation Outcome for In-hospital Adult Patients
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In Byung Kim, Sang Won Chung, Dong Seok Moon, Ki Hyun Byun
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Korean J Crit Care Med. 2007;22(2):83-90.
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Abstract
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- BACKGROUND
The purpose of this study was to evaluate the factors of cardiopulmonary resuscitation (CPR) outcome for in-hospital adult patients, acquiring data with standardized reporting guideline of in-hospital cardiopulmonary resuscitation in Korea.
METHODS
All adult cardiac arrest patients from July 2004 to December 2006 in this general hospital were included. Their clinical spectrums were reviewed retrospectively using Utstein-style based template.
RESULTS
For the study time period, one hundred and forty-two patients underwent cardiac arrest in this hospital. 136 patients were performed CPR. Return of spontaneous circulation (ROSC) occurred in 42 cases, and 15 patients were survived to hospital discharge. A shorter CPR time and a lower Simplified Acute Physiology Score II (SAPS II) were significant for survivor to hospital discharge (p<0.01). Sex, age, and location in cardiac arrest were not attributed to survival to hospital discharge.
CONCLUSIONS
In-hospital CPR patients, the high rate of ROSC and survival to hospital discharge were associated to the cause of arrest, shorter time of CPR, and lesser severity of disease (SAPS II). This result can be a great implication of survivor from CPR in-hospital adult patients in Korea.
Further evaluation with consistent data acquisition of CPR using Utstein-style would contribute to improve CPR practice and outcome.
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