• Maxime Cannesson, Yassin Attof, Pascal Rosamel, Olivier Desebbe, Pierre Joseph, Olivier Metton, Olivier Bastien, and Jean-Jacques Lehot.
• Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon I University, France. maxime_cannesson@hotmail.com
• Anesthesiology. 2007 Jun 1;106(6):1105-11.

BackgroundRespiratory variations in pulse oximetry plethysmographic waveform amplitude (DeltaPOP) are related to respiratory variations in pulse pressure (DeltaPP) and are sensitive to changes in preload. The authors hypothesized that DeltaPOP can predict fluid responsiveness in mechanically ventilated patients during general anesthesia.MethodsTwenty-five patients referred for cardiac surgery were studied after induction of general anesthesia. Hemodynamic data (cardiac index, central venous pressure, pulmonary capillary wedge pressure, DeltaPP, and DeltaPOP) were recorded before and after volume expansion (500 ml hetastarch, 6%). Fluid responsiveness was defined as an increase in cardiac index of 15% or greater.ResultsVolume expansion induced changes in cardiac index (2.0+/-0.4 to 2.3+/-0.5 mmHg; P<0.05), DeltaPP (11+/-7 to 6+/-5%; P<0.05), and DeltaPOP (12+/-9 to 7+/-5%; P<0.05). DeltaPOP and DeltaPP were higher in responders than in nonresponders (17+/-8 vs. 6+/-4 and 14+/-7 vs. 6+/-4%, respectively; P<0.05 for both). A DeltaPOP greater than 13% before volume expansion allowed discrimination between responders and nonresponders with 80% sensitivity and 90% specificity. There was a significant relation between DeltaPOP before volume expansion and percent change in cardiac index after volume expansion (r=0.62; P<0.05).ConclusionsDeltaPOP can predict fluid responsiveness noninvasively in mechanically ventilated patients during general anesthesia. This index has potential clinical applications.

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