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Noninvasive continuous detection of arterial hypotension during induction of anaesthesia using a photoplethysmographic signal: proof of concept

Authors :
Maxime Coutrot
François Dépret
Etienne Gayat
Fabrice Vallée
Sandrine Millasseau
Hélène Nougué
Alexandre Mebazaa
Jona Joachim
Joaquim Mateo
Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942))
Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)
Université Paris Diderot - Paris 7 (UPD7)
Pulse wave consulting [Saint-Leu-la-forêt]
Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine (M3DISIM)
Laboratoire de mécanique des solides (LMS)
École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris
Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-MINES ParisTech - École nationale supérieure des mines de Paris
Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Inria Saclay - Ile de France
Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)
Université Paris 13 (UP13)-Université Paris-Sud - Paris 11 (UP11)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)
École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris)
Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-École polytechnique (X)-Mines Paris - PSL (École nationale supérieure des mines de Paris)
Source :
British Journal of Anaesthesia, British Journal of Anaesthesia, Oxford University Press (OUP), 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩, British Journal of Anaesthesia, 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩
Publication Year :
2019
Publisher :
HAL CCSD, 2019.

Abstract

Background During general anaesthesia, intraoperative hypotension (IOH), defined as a mean arterial pressure (MAP) reduction of > 20%, is frequent and may lead to complications. Pulse oximetry is mandatory in the operating room, making the photoplethysmographic signal and parameters, such as relative dicrotic notch height (Dicpleth) or perfusion index (PI), readily available. The purpose of this study was to investigate whether relative variations of Dicpleth and PI could detect IOH during anaesthesia induction, and to follow their variations during vasopressor boluses. Methods MAP, Dicpleth, and PI were monitored at 1-min intervals during target control induction of anaesthesia with propofol and remifentanil in 61 subjects. Vasopressor infusion (norepinephrine or phenylephrine) was performed when hypotension occurred according to the decision of the physician. Results The delta in Dicpleth and PI accurately detected IOH, with areas under the receiver operating characteristic curves (AUC) of 0.86 and 0.83, respectively. The optimal thresholds were –19% (sensitivity 79%; specificity 84%) and 51% (sensitivity 82%; specificity 74%) for ΔDicpleth and ΔPI, respectively. There was no difference between the ROC of ΔDicpleth and ΔPI (P=0.22). Combining both ΔDicpleth and ΔPI further improved the hypotension detection power (AUC=0.91) with a sensitivity and specificity of 84%. MAP variations were correlated with ΔDicpleth and ΔPI during vasopressor infusion (r=0.73 and –0.62, respectively; P Conclusions The relative variation in Dicpleth and PI derived from the photoplethysmographic signal can be used as a non invasive, continuous, and simple tool to detect intraoperative hypotension, and to track the vascular response to vasoconstrictor drugs during induction of general anaesthesia. Clinical trial registration NCT03756935 .

Details

Language :
English
ISSN :
00070912 and 14716771
Database :
OpenAIRE
Journal :
British Journal of Anaesthesia, British Journal of Anaesthesia, Oxford University Press (OUP), 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩, British Journal of Anaesthesia, 2019, 122, pp.605-612. ⟨10.1016/j.bja.2019.01.037⟩
Accession number :
edsair.doi.dedup.....4770bdabdc462cdd6da59248115941a5
Full Text :
https://doi.org/10.1016/j.bja.2019.01.037⟩