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Variations in pulse oximetry plethysmographic waveform amplitude induced by passive leg raising in spontaneously breathing volunteers.

Delerme S, Renault R, Le Manach Y, Lvovschi V, Bendahou M, Riou B, Ray P

Department of Emergency Medicine and Surgery, CHU Pitié-Salpêtrière, Assitance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris, 75013 Paris, France.

PURPOSE: Noninvasive methods that could predict preload responsiveness are lacking. Our objective was to evaluate variations in pulse oximetry plethysmographic (POP) waveform amplitude (deltaPOP) induced by passive leg raising (PLR). METHODS: We attached a pulse oximeter to the middle finger of 25 spontaneously breathing volunteers at several time points: baseline (ie, semirecumbent position), during PLR at 60 degrees while each subject's trunk was lowered in a supine position at 1 minute, and after putting the patient back in the semirecumbent position (5-minute rest). Heart rate, noninvasive arterial pressures (mean arterial pressure and pulse pressure), maximal POP (POPmax), minimal POP (POPmin), and deltaPOP defined as [POPmax - POPmin]/[(POPmax + POPmin)/2] were recorded using a monitor. RESULTS: Heart rate, mean arterial pressure, pulse pressure, POPmax, and POPmin values were not different at baseline, during PLR at 1 minute, and after the 5-minute rest (repeated-measures analysis of variance). The median deltaPOP significantly decreased from 16% (95% confidence interval = 11%-23%) to 11% (95% confidence interval = 8%-14%) (P < .05) and then increased to 13% (95% confidence interval = 10%-21%) after the 5-minute rest (P = nonsignificant). CONCLUSION: Passive leg raising induces a significant decrease in deltaPOP among spontaneously breathing volunteers.

Published 3 July 2007 in Am J Emerg Med, 25(6): 637-42.
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