British Journal of Anaesthesia ( IF 9.8 ) Pub Date : 2017-12-13 , DOI: 10.1093/bja/aex271 K.M. Hocking , B.D. Alvis , F. Baudenbacher , R. Boyer , C.M. Brophy , I. Beer , S. Eagle
Background
The assessment of intravascular volume status remains a challenge for clinicians. Peripheral i.v. analysis (PIVA) is a method for analysing the peripheral venous waveform that has been used to monitor volume status. We present a proof-of-concept study for evaluating the efficacy of PIVA in detecting changes in fluid volume.
Methods
We enrolled 37 hospitalized patients undergoing haemodialysis (HD) as a controlled model for intravascular volume loss. Respiratory rate (F0) and pulse rate (F1) frequencies were measured. PIVA signal was obtained by fast Fourier analysis of the venous waveform followed by weighing the magnitude of the amplitude of the pulse rate frequency. PIVA was compared with peripheral venous pressure and standard monitoring of vital signs.
Results
Regression analysis showed a linear correlation between volume loss and change in the PIVA signal (R2=0.77). Receiver operator curves demonstrated that the PIVA signal showed an area under the curve of 0.89 for detection of 20 ml kg−1 change in volume. There was no correlation between volume loss and peripheral venous pressure, blood pressure or pulse rate. PIVA-derived pulse rate and respiratory rate were consistent with similar numbers derived from the bio-impedance and electrical signals from the electrocardiogram.
Conclusions
PIVA is a minimally invasive, novel modality for detecting changes in fluid volume status, respiratory rate and pulse rate in spontaneously breathing patients with peripheral i.v. cannulas.
中文翻译:
进行血液透析患者的静脉波形的外周静脉分析(PIVA)以进行体积评估
背景
血管内容积状态的评估仍然是临床医生面临的挑战。外周静脉分析(PIVA)是一种用于分析已用于监视体积状态的外周静脉波形的方法。我们提出了一项概念验证研究,用于评估PIVA在检测体液量变化中的功效。
方法
我们招募了37名接受血液透析(HD)住院治疗的患者作为血管内容量减少的对照模型。测量呼吸频率(F 0)和脉搏频率(F 1)。PIVA信号是通过对静脉波形进行快速傅立叶分析,然后对脉搏频率频率的幅度进行加权来获得的。将PIVA与外周静脉压和生命体征的标准监测进行了比较。
结果
回归分析显示,体积损失与PIVA信号变化之间存在线性关系(R 2 = 0.77)。接收器操作员曲线表明,PIVA信号在0.89的曲线下显示出一个面积,用于检测20 ml kg -1的体积变化。体积减少与周围静脉压,血压或脉搏率之间无相关性。PIVA衍生的脉搏频率和呼吸频率与从生物阻抗和心电图的电信号得出的相似数字一致。
结论
PIVA是一种微创的新模式,用于检测自发呼吸的外周静脉插管患者的体液状态,呼吸频率和脉搏频率的变化。