Peripheral venous pressure waveform

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Simulated hypovolemia and general anesthesia volume responsiveness (n=35). Intervention: Peripheral intravenous pressure waveform analysis fundamental frequency (PIVA F1) during simulated hypovolemia (LBNP) and head-down tilt vs. Baseline (LBNP 0 mmHg or horizontal supine position). Primary outcome: Change in log_e(PIVA F1) per 10 mmHg increase in lower body negative pressure (LBNP) (MD -0.11 per 10 mmHg LBNP, 95% CI -0.14 to -0.09, p=< 0.001).

Q: What does this research mean for the field?

Peripheral intravenous pressure waveform fundamental frequency amplitude (PIVA F1) decreases during simulated hypovolemia but fails to predict stroke volume changes induced by head-down tilt under general anesthesia. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Richa Wardhan; Kirk H. Shelley

doi:10.1097/aco.0b013e328332a343

October 31, 2009Current Opinion in Anaesthesiology

Peripheral venous pressure waveform

View at Publisher

Ask AI

Bookmark

Share

Why the study?

Intraoperative monitoring is moving away from invasive techniques because of procedure time, cost, and procedural risks, while the circulatory contribution of the peripheral venous system was previously considered insignificant.

Key Points

To review the physiological characteristics of peripheral venous pressure waveforms and evaluate their potential utility as a minimally invasive tool for hemodynamic monitoring.
Assessed peripheral venous waveform behavior across clinical literature and physiological cohorts, including healthy volunteers undergoing lower body negative pressure (n=15) and anesthetized surgical patients undergoing head-down tilt (n=20).
Analyzed peripheral intravenous pressure waveform fundamental frequency amplitude (PIVA F1) during hypovolemic challenge and fluid shifts.
Peripheral venous pressure waveforms exhibit respiratory variations and cardiac-synchronous oscillations that reflect acute shifts in circulating volume.
In simulated hypovolemia, log e (PIVA F1) amplitude decreased significantly by -0.11 (95% CI: -0.14 to -0.09, P < 0.001) for each 10 mmHg increase in lower body negative pressure.
PIVA F1 failed to reliably predict a 10% increase in stroke volume following head-down tilt under general anesthesia [AUC 0.71 (95% CI: 0.47 to 0.96; P = 0.11)].

Study Design

Type

Observational (n=35)

Multicenter

No

PICO

P

Population

35 participants in Norway comprising 15 healthy volunteers (median age 24 years, 47% female) undergoing progressive lower body negative pressure and 20 patients (mean age 60 years, 35% female) undergoing head-down tilt under general anesthesia.

E

Exposure / Comparator

Peripheral intravenous pressure waveform analysis fundamental frequency (PIVA F1) during simulated hypovolemia (LBNP) and head-down tilt vs Baseline (LBNP 0 mmHg or horizontal supine position) (LBNP from 0 to 80 mmHg in 10 mmHg increments (2 min per level); 30-second head-down tilt)

O

Primary Outcome

Change in log_e(PIVA F1) per 10 mmHg increase in lower body negative pressure (LBNP) — MD -0.11 per 10 mmHg LBNP (-0.14 to -0.09), p=< 0.001

Main Result

Mean Difference: -0.11 (95% CI -0.14–-0.09)

Absolute Event Rate: -0.11% vs -2.6%

p-value: p=< 0.001

Limitations

Small sample size (15 healthy volunteers and 20 surgical patients)
Five patients in the general anesthesia cohort received noradrenaline infusions, which has unknown effects on the PIVA signal
Lower body negative pressure simulates hypovolemia without tissue damage, limiting validity for trauma patients
Different data transformations required between cohorts (log-transformation used in LBNP cohort but not primary GA cohort analysis)
Inherent limitations in esophageal Doppler stroke volume measurements, including potential probe movement during head-down tilt
No simultaneous fluid infusion was tested through the peripheral venous cannulas during waveform recording
Presumed small variability in volume status in the general anesthesia cohort (spectrum effect)

Implication

PIVA F1 does not predict stroke volume response under anesthesia; leaves open its role for venous pressure monitoring.

Abstract

PURPOSE OF REVIEW: The focus of intraoperative monitoring is moving away from invasive monitoring. This has been attributed to procedure time, cost, and the known risks, which include carotid artery puncture, arrhythmia, pneumothorax, and infection. Until recently, the venous system's contribution to the circulatory system has been incorrectly identified as being insignificant. This article summarizes the unique characteristics of the peripheral venous system. RECENT FINDINGS: Numerous studies done in the last few years have paid attention to peripheral venous pressure and more specifically its pressure waveform. The popularity of, and further focus on, the field of photoplethysmography has described a strong venous component. Analysis of venous waveforms has indicated that, like arterial waveforms, they too exhibit respiratory variations and change in response to physiologic challenges. SUMMARY: The veins play a critical role in cardiovascular homeostasis; they do more than conduct blood to the heart. Considering the ease of measurement from a peripheral intravenous catheter, further study should be conducted to investigate the usefulness and limitations of such a minimally invasive and inexpensive monitoring device.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Wardhan et al. (2009) conducted an observational in Simulated hypovolemia and general anesthesia volume responsiveness (n=35). Peripheral intravenous pressure waveform analysis fundamental frequency (PIVA F1) during simulated hypovolemia (LBNP) and head-down tilt vs. Baseline (LBNP 0 mmHg or horizontal supine position) was evaluated on Change in log_e(PIVA F1) per 10 mmHg increase in lower body negative pressure (LBNP) (MD -0.11 per 10 mmHg LBNP, 95% CI -0.14 to -0.09, p=< 0.001).

synapsesocial.com/papers/6add66af994d43472c8fcba6 https://doi.org/10.1097/aco.0b013e328332a343

View at Publisher

Ask AI

Bookmark

Share

Peripheral venous pressure waveform

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Peripheral venous pressure waveform

Key Points

Study Design

PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading