Kagihara Jamie, Guo Xinning, Baydur Ahmet
Los Angeles General Medical Center, Los Angeles, CA 90033, USA.
Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Diagnostics (Basel). 2025 Mar 21;15(7):798. doi: 10.3390/diagnostics15070798.
We sought to assess variations in pulse oximetry waveform amplitude (ΔP) and peak values (ΔS) separately during passive leg raising (PLR) and challenge plus maintenance crystalloid volume resuscitation over time in mechanically ventilated (MV) patients in shock. Variables were recorded and analayzed using previously described techniques. Findings were compared between the following: at baseline, during passive leg raising (PLR), with 0.9% normal saline administration (or removal), and applying tidal volume (Vt), peak, and mean airway pressure (Paw,peak and Paw,mean, respectively) and positive end-expiratory pressure (PEEP) as covariates in multifactorial logistic regression analysis. Twenty patients with sepsis or septic shock were included in the analysis. Origins of sepsis varied. Their diagnoses upon admission to the intensive care unit included sepsis in nine (45%), septic shock (defined as the need for vasopressors) in nine (45%), and one (5%) rescuscitated from pulseless electrical activity following heroin overdose, all of whom were supported by volume control MV. Eleven patients required vasoactive drugs at the outset, of which seven were on norepinephrine. Three patients required surgical drainage or removal of necrotic tissue. Median ΔP and ΔS decreased, respectively, by 42% and 37% with PLR ( = 0.036 and = 0.061, respectively). There were no significant changes in ΔP and ΔS between PLR and net fluid volume administered. Correction for body weight did not change these relationships. Application of Vt, Paw,peak, Paw,mean, and PEEP did not significantly influence these changes. Hemodynamic repsonse to slow fluid volume administration can be assessed by changes in the pulse oximetry waveform amplitude over time. The effects of mechanical ventilation are negligible.
我们试图分别评估在被动抬腿（PLR）以及对休克的机械通气（MV）患者进行挑战加维持晶体液容量复苏过程中，随着时间推移脉搏血氧饱和度波形幅度（ΔP）和峰值（ΔS）的变化情况。使用先前描述的技术记录并分析变量。在以下情况之间比较研究结果：基线时、被动抬腿（PLR）期间、给予（或去除）0.9%生理盐水时，以及在多因素逻辑回归分析中，将潮气量（Vt）、峰值气道压和平均气道压（分别为Paw,peak和Paw,mean）以及呼气末正压（PEEP）作为协变量时。分析纳入了20例脓毒症或脓毒性休克患者。脓毒症的来源各不相同。他们入住重症监护病房时的诊断包括9例（45%）脓毒症、9例（45%）脓毒性休克（定义为需要血管加压药），以及1例（5%）海洛因过量后从无脉电活动中复苏的患者，所有这些患者均接受容量控制MV支持。11例患者一开始需要血管活性药物，其中7例使用去甲肾上腺素。3例患者需要手术引流或清除坏死组织。PLR时，ΔP和ΔS的中位数分别下降了42%和37%（分别为 = 0.036和 = 0.061）。PLR和给予的净液体量之间，ΔP和ΔS没有显著变化。校正体重并未改变这些关系。应用Vt、Paw,peak、Paw,mean和PEEP并未显著影响这些变化。通过脉搏血氧饱和度波形幅度随时间的变化，可以评估对缓慢液体量输注的血流动力学反应。机械通气的影响可忽略不计。
