Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
Eur J Med Res. 2023 Feb 3;28(1):64. doi: 10.1186/s40001-023-01031-8.
Atelectasis can occur in many clinical practices. One way to prevent this complication is through the alveolar recruitment maneuver (ARM). However, hemodynamic compromise can accompany ARM. This study aims to predict ARM-induced hypotension using a non-invasive method.
94 American Society of Anesthesiologists physical status I-II patients aged 19 to 75 with scheduled spinal surgery were enrolled. After anesthesia, we performed a stepwise ARM. Data on perfusion index, mean arterial pressure, heart rate, pleth variability index, cardiac index, and stroke volume variation was collected before induction of anesthesia (T0), just before ARM (T1), at the start of ARM (T2), 0.5 min (T3), 1 min (T4), 1.5 min (T5, end of ARM), and 2 min after the beginning of ARM (T6). Hypotension was defined as when the mean arterial pressure at T5 decreased by 20% or more compared to the baseline. The primary endpoint is that the perfusion index measuring before induction of anesthesia, which reflects the patients' own vascular tone, was correlated with hypotension during ARM.
Seventy-five patients (79.8%) patients developed hypotension during ARM. The pre-induction persufion index (Pi) (95% confidence interval) was 1.7(1.4-3.1) in the non-hypotension group and 3.4(2.4-3.9) in the hypotension group. (p < 0.004) The hypotension group showed considerably higher Pi than the non-hypotension group before induction. The decrease of Pi (%) [IQR] in the non-hypotensive group (52.8% [33.3-74.7]) was more significant than in the hypotensive group. (36% [17.6-53.7]) (p < 0.05) The area under the receiver operating characteristic curve of Pi for predicting hypotension during ARM was 0.718 (95% CI 0.615-0.806; p = 0.004), and the threshold value of the Pi was 2.4.
A higher perfusion index value measuring before induction of anesthesia can be used to predict the development of hypotension during ARM. Prophylactic management of the following hypotension during ARM could be considered in high baseline Pi patients.
在许多临床实践中都会发生肺不张。预防这种并发症的一种方法是进行肺泡复张手法（ARM）。然而，ARM 可能会伴随血流动力学障碍。本研究旨在使用一种非侵入性方法预测 ARM 引起的低血压。
本研究纳入了 94 名美国麻醉医师协会（ASA）身体状况 I-II 级、年龄在 19 至 75 岁之间、拟行脊柱手术的患者。麻醉后，我们进行逐步的 ARM。在麻醉诱导前（T0）、ARM 前（T1）、ARM 开始时（T2）、0.5 分钟（T3）、1 分钟（T4）、1.5 分钟（T5，ARM 结束时）和 ARM 开始后 2 分钟（T6）采集灌注指数、平均动脉压、心率、 pleth 变异性指数、心指数和每搏量变异。低血压定义为 T5 时的平均动脉压与基础值相比下降 20%或更多。主要终点是麻醉诱导前测量的灌注指数（反映患者自身血管张力）与 ARM 期间的低血压相关。
75 名患者（79.8%）在 ARM 期间发生低血压。非低血压组的预诱导灌注指数（Pi）（95%置信区间）为 1.7（1.4-3.1），低血压组为 3.4（2.4-3.9）。（p<0.004）低血压组在诱导前的 Pi 值明显高于非低血压组。非低血压组的 Pi 值下降（%）[IQR]明显大于低血压组（52.8%[33.3-74.7]对 36%[17.6-53.7]）。（p<0.05）Pi 预测 ARM 期间低血压的受试者工作特征曲线下面积为 0.718（95%CI 0.615-0.806；p=0.004），Pi 的阈值为 2.4。
麻醉诱导前测量的较高的灌注指数值可用于预测 ARM 期间低血压的发生。对于基线 Pi 值较高的患者，可考虑在 ARM 期间预防性处理低血压。
