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Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients.
BMC Anesthesiol. 2019 12 27; 19(1):242.BA

Abstract

BACKGROUND

Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension.

METHODS

A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation.

RESULTS

Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4-136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59-0.88)}, and 0.721(0.547-0.857)} respectively.

CONCLUSIONS

Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension.

Authors+Show Affiliations

Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt. ahmed.hasanin@kasralainy.edu.eg. Department of Anesthesia and Critical Care Medicine, 01 Elsarayah street, Cairo, 11559, Egypt. ahmed.hasanin@kasralainy.edu.eg.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.Department of Anesthesia, Cairo University, Giza, Egypt.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

31881971

Citation

Mostafa, Hanan, et al. "Evaluation of Peripheral Perfusion Index and Heart Rate Variability as Early Predictors for Intradialytic Hypotension in Critically Ill Patients." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 242.
Mostafa H, Shaban M, Hasanin A, et al. Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients. BMC Anesthesiol. 2019;19(1):242.
Mostafa, H., Shaban, M., Hasanin, A., Mohamed, H., Fathy, S., Abdelreheem, H. M., Lotfy, A., Abougabal, A., Mukhtar, A., & El-Adawy, A. (2019). Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients. BMC Anesthesiology, 19(1), 242. https://doi.org/10.1186/s12871-019-0917-1
Mostafa H, et al. Evaluation of Peripheral Perfusion Index and Heart Rate Variability as Early Predictors for Intradialytic Hypotension in Critically Ill Patients. BMC Anesthesiol. 2019 12 27;19(1):242. PubMed PMID: 31881971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients. AU - Mostafa,Hanan, AU - Shaban,Mohamed, AU - Hasanin,Ahmed, AU - Mohamed,Hassan, AU - Fathy,Shymaa, AU - Abdelreheem,Hossam M, AU - Lotfy,Ahmed, AU - Abougabal,Ayman, AU - Mukhtar,Ahmed, AU - El-Adawy,Akram, Y1 - 2019/12/27/ PY - 2019/04/07/received PY - 2019/12/19/accepted PY - 2019/12/29/entrez PY - 2019/12/29/pubmed PY - 2020/9/18/medline KW - Heart rate variability KW - Intradialytic hypotension KW - Peripheral perfusion index SP - 242 EP - 242 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Intradialytic hypotension is a serious complication during renal replacement therapy in critically ill patients. Early prediction of intradialytic hypotension could allow adequate prophylactic measures. In this study we evaluated the ability of peripheral perfusion index (PPI) and heart rate variability (HRV) to predict intradialytic hypotension. METHODS: A prospective observational study included 36 critically ill patients with acute kidney injury during their first session of intermittent hemodialysis. In addition to basic vital signs, PPI was measured using Radical-7 (Masimo) device. Electrical cardiometry (ICON) device was used for measuring cardiac output, systemic vascular resistance, and HRV. All hemodynamic values were recorded at the following time points: 30 min before the hemodialysis session, 15 min before the start of hemodialysis session, every 5 min during the session, and 15 min after the conclusion of the session. The ability of all variables to predict intradialytic hypotension was assessed through area under receiver operating characteristic (AUROC) curve calculation. RESULTS: Twenty-three patients (64%) had intradialytic hypotension. Patients with pulmonary oedema showed higher risk for development of intradialytic hypotension {Odds ratio (95% CI): 13.75(1.4-136)}. Each of baseline HRV, and baseline PPI showed good predictive properties for intradialytic hypotension {AUROC (95% CI): 0.761(0.59-0.88)}, and 0.721(0.547-0.857)} respectively. CONCLUSIONS: Each of low PPI, low HRV, and the presence of pulmonary oedema are good predictors of intradialytic hypotension. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31881971/Evaluation_of_peripheral_perfusion_index_and_heart_rate_variability_as_early_predictors_for_intradialytic_hypotension_in_critically_ill_patients_ L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0917-1 DB - PRIME DP - Unbound Medicine ER -