Clark Jeff A, Lieh-Lai Mary, Thomas Ron, Raghavan Kalyani, Sarnaik Ashok P
Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, 48201-2196, USA.
Arch Pediatr Adolesc Med. 2004 Jan;158(1):48-51. doi: 10.1001/archpedi.158.1.48.
In the evaluation of patients with acute asthma, pulsus paradoxus (PP) is an objective and noninvasive indicator of the severity of airway obstruction. However, in children PP may be difficult or impossible to measure. Indwelling arterial catheters facilitate the measurement of PP, but they are invasive and generally reserved for critically ill patients.
To determine the utility of the plethysmographic waveform (PPpleth) of the pulse oximeter in measuring PP.
Patients from the pediatric intensive care unit, emergency department, and inpatient wards of a tertiary care pediatric hospital were eligible for the study. A total of 36 patients (mean age [SD], 11.2 [4.7] years) were enrolled in the study. Pulsus paradoxus was measured using the traditional auscultatory (PPausc) method with a sphygmomanometer. Pulsus paradoxus was then measured using a blood pressure cuff observing for the disappearance and reappearance of the (PPpleth) on the pulse oximeter. Mean difference and 95% confidence intervals were calculated for each method. The 2 methods were also analyzed for correlation and agreement using the Pearson product moment correlation and a Bland and Altman plot.
Patients with status asthmaticus had higher PPausc and PPpleth readings compared with nonasthmatic patients. Pulsus paradoxus measured by plethysmography in patients with and without asthma was similar to PPausc readings (mean difference, 0.6 mm Hg; 95% confidence interval, -0.6 to 2.1 mm Hg). Individual PPpleth readings showed significant correlation and agreement with PPausc readings in patients both with and without asthma.
Measurement of PP using the pulse oximeter-pulse plethysmographic waveform offers a simple and noninvasive method for evaluating patients with airway obstruction.
在评估急性哮喘患者时，奇脉（PP）是气道阻塞严重程度的客观且非侵入性指标。然而，在儿童中，PP可能难以测量或无法测量。留置动脉导管有助于PP的测量，但具有侵入性，通常仅用于危重症患者。
确定脉搏血氧饱和度仪的体积描记波形（PPpleth）在测量PP中的效用。
来自一家三级儿科医院的儿科重症监护病房、急诊科和住院病房的患者符合研究条件。共有36名患者（平均年龄[标准差]，11.2[4.7]岁）纳入研究。使用血压计通过传统听诊法（PPausc）测量奇脉。然后使用血压袖带测量奇脉，观察脉搏血氧饱和度仪上PPpleth的消失和重现情况。计算每种方法的平均差异和95%置信区间。还使用Pearson积矩相关性和Bland-Altman图分析两种方法的相关性和一致性。
与非哮喘患者相比，哮喘持续状态患者的PPausc和PPpleth读数更高。通过体积描记法测量的有哮喘和无哮喘患者的奇脉与PPausc读数相似（平均差异，0.6mmHg；95%置信区间，-0.6至2.1mmHg）。在有哮喘和无哮喘的患者中，个体PPpleth读数与PPausc读数均显示出显著的相关性和一致性。
使用脉搏血氧饱和度仪-脉搏体积描记波形测量PP为评估气道阻塞患者提供了一种简单且非侵入性的方法。
