• Kevin L Webb, Wyatt W Pruter, Ruth J Poole, Robert W Techentin, Christopher P Johnson, Riley J Regimbal, Kaylah J Berndt, David R Holmes, Clifton R Haider, Michael J Joyner, Victor A Convertino, Chad C Wiggins, and Timothy B Curry.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St. SW, 55905, Rochester, Minnesota, MN, USA.
• J Clin Monit Comput. 2024 Dec 1; 38 (6): 133713461337-1346.

PurposeThe compensatory reserve metric (CRM) is a novel tool to predict cardiovascular decompensation during hemorrhage. The CRM is traditionally computed using waveforms obtained from photoplethysmographic volume-clamp (PPGVC), yet invasive arterial pressures may be uniquely available. We aimed to examine the level of agreement of CRM values computed from invasive arterial-derived waveforms and values computed from PPGVC-derived waveforms.MethodsSixty-nine participants underwent graded lower body negative pressure to simulate hemorrhage. Waveform measurements from a brachial arterial catheter and PPGVC finger-cuff were collected. A PPGVC brachial waveform was reconstructed from the PPGVC finger waveform. Thereafter, CRM values were computed using a deep one-dimensional convolutional neural network for each of the following source waveforms; (1) invasive arterial, (2) PPGVC brachial, and (3) PPGVC finger. Bland-Altman analyses were used to determine the level of agreement between invasive arterial CRM values and PPGVC CRM values, with results presented as the Mean Bias [95% Limits of Agreement].ResultsThe mean bias between invasive arterial- and PPGVC brachial CRM values at rest, an applied pressure of -45mmHg, and at tolerance was 6% [-17%, 29%], 1% [-28%, 30%], and 0% [-25%, 25%], respectively. Additionally, the mean bias between invasive arterial- and PPGVC finger CRM values at rest, applied pressure of -45mmHg, and tolerance was 2% [-22%, 26%], 8% [-19%, 35%], and 5% [-15%, 25%], respectively.ConclusionThere is generally good agreement between CRM values obtained from invasive arterial waveforms and values obtained from PPGVC waveforms. Invasive arterial waveforms may serve as an alternative for computation of the CRM.© 2024. The Author(s), under exclusive licence to Springer Nature B.V.

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