Key result
During laryngeal microsurgery, the inverse of pulse arrival time significantly correlated with changes in systolic blood pressure (r=0.582; P<0.001), yielding an AUC of 0.814 for detecting a 40% SBP increase.
Why the study?
Laryngeal microsurgery is often accompanied by sudden blood pressure surges from laryngeal stimulation that intermittent cuff measurements taken every 3 to 5 minutes fail to detect immediately.
Does pulse arrival time (PAT) monitoring accurately detect sudden hypertensive episodes in patients undergoing laryngeal microsurgery?
Observational
Does pulse arrival time (PAT) monitoring accurately detect sudden hypertensive episodes in patients undergoing laryngeal microsurgery?
Effect estimate: r=0.582
p-value: p=<0.001
Pulse arrival time calculated from ECG and PPG signals correlates significantly with systolic blood pressure changes and can noninvasively detect sudden hypertensive episodes during laryngeal microsurgery.
May support noninvasive hypertensive episode detection during laryngeal microsurgery; leaves open prospective validation before clinical adoption.
BACKGROUND Laryngeal microsurgery (LMS) is often accompanied by a sudden increase in blood pressure (BP) during surgery because of stimulation around the larynx. This sudden change in the hemodynamic status is not immediately reflected in a casual cuff-type measurement that takes intermittent readings every 3 to 5 min. OBJECTIVE This study aimed to investigate the potential of pulse arrival time (PAT) as a marker for a BP surge, which usually occurs in patients undergoing LMS. METHODS Intermittent measurements of BP and electrocardiogram (ECG) and photoplethysmogram (PPG) signals were recorded during LMS. PAT was defined as the interval between the R-peak on the ECG and the maximum slope on the PPG. Mean PAT values before and after BP increase were compared. PPG-related parameters and the correlations between changes in these variables were calculated. RESULTS BP surged because of laryngoscopic manipulation (mean systolic BP [SBP] from 115.3, SD 21.4 mmHg, to 159.9, SD 25.2 mmHg; P<.001), whereas PAT decreased significantly (from mean 460.6, SD 51.9 ms, to 405.8, SD 50.1 ms; P<.001) in most of the cases. The change in SBP showed a significant correlation with the inverse of the PAT (r=0.582; P<.001). Receiver-operating characteristic curve analysis indicated that an increase of 11.5% in the inverse of the PAT could detect a 40% increase in SBP, and the area under the curve was 0.814. CONCLUSIONS During LMS, where invasive arterial catheterization is not always possible, PAT shows good correlation with SBP and may, therefore, have the potential to identify abrupt BP surges during laryngoscopic manipulations in a noninvasive manner. CLINICALTRIAL
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Park et al. (2018) conducted an observational in Laryngeal microsurgery. Pulse arrival time (PAT) was evaluated on Correlation between change in systolic blood pressure and inverse of pulse arrival time (r=0.582, p=<0.001). During laryngeal microsurgery, the inverse of pulse arrival time significantly correlated with changes in systolic blood pressure (r=0.582; P<0.001), yielding an AUC of 0.814 for detecting a 40% SBP increase.
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