Spontan Solunumu Olan Gönüllülerde Cerrahi Hasta Pozisyonlarının Plet Değişkenlik İndeksi , Perfüzyon İndeksi ve Noninvaziv Sürekli Kardiyak Output Ölçüm Yöntemi Üzerine Olan Etkisi

Year 2020, Volume: 17 Issue: 1, 98 - 103, 29.04.2020

Mahmut Alp Karahan , Ahmet Atlas Veli Pehlivan Erdoğan Duran , Başak Pehlivan Melike Aban Orhan Binici , Nuray Altay

https://doi.org/10.35440/hutfd.691101

Cited By: 2

Abstract

Amaç: Cerrahi prosedür için verilen farklı pozisyonlar doku perfüzyonunda ve kardiyak outputta değişikliklere neden olabilir. Bu çalışmada spontan solunuma sahip katılımcılarda plet değişkenlik indeksinin (PVI), perfüzyon indeks (PI) ve noninvaziv sürekli kardiyak output ölçüm yöntemi (EscCO) nin farklı cerrahi pozisyonlardaki değişimlerini araştırmayı amaçladık.
Materyal ve Metod: 20 katılımcıdan oluşan bir sağlıklı birey grubu prospektif gözlemsel çalışmaya dahil edildi. Sırasıyla Supin, 30 derece baş yukarı, 45 derece baş yukarı, 20 derece Trendelenburg, 20 derece ters-Trendelenburg, ve pron pozisyonları uygulandı. Her pozisyon arası 10 ar dk olacak şekilde süre tutuldu. Her pozisyon değişikliğinden önce gönüllüler sırtüstü pozisyona alındı ve beş dakika dinlendikten sonra yeni pozisyon verildi. Pozisyon değişiminden sonraki 5. dakika PI, PVI, EscCO, SpO2 değerleri kayıt altına alındı.
Bulgular: Katılımcıların farklı pozisyondayken ölçülen PI, PVI ile EscCO değerlerinde istatistiksel olarak anlamlı bir fark bulunamadı.
Sonuç: Bu çalışma, PI, PVI ile EscCO nun tüm cerrahi pozisyonlarda herhangi bir değişikliğe uğramadığını ve her üç parametrenin de spontan solunumuna sahip genç sağlıklı bireylerde pozisyondan etkilenmediği ortaya koymuştur.

Keywords

Kardiyak Output, Cerrahi, Perfüzyon İndeksi

The Effect of Surgical Patient Positions on Plet Variability Index, Perfusion Index and Noninvasive Continuous Cardiac Output Measurement Method in Voluntary Breathing Volunteers

Abstract

Background: Different positions given for the surgical procedure can cause changes in tissue perfusion and cardiac output. In this study, we aimed to investigate the changes of pleth variability index (PVI), perfusion index (PI) and noninvasive continuous cardiac output measurement method (EscCO) in different surgical positions in participants with spontaneous breathing.
Materials and Methods: A sample of 20 healthy individuals was included in the prospective observational this study. Participants held six different positions: supine, prone, 30 degrees upside, 45 degrees upside, trendelenburg (20-degrees head down), and reverse trendelenburg (20-degrees head up). The time was kept 10 minutes between each position. Before each position change, volunteers were placed in the supine position and after five minutes of rest, a new position was given. After the position change, PI, PVI, EscCO, peripheral capillary oxygen saturation values at 5th minutes were recorded.
Results: No statistically significant difference was found in PI, PVI and EscCO values measured while the participants were in different positions (p >0.05).
Conclusion: This study revealed that PI, PVI and EscCO did not change in all surgical positions, and this parameters were not affected by position in young healthy individuals with spontaneous breathing.

Keywords

cardiac output, surgery, perfusion index

References

• Referans1) Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG et al. The effect of patient positions on perfusion index. BMC Anesthesiol. 2018;18(1):111
• Referans2) Kim DH, Shin S, Kim JY, Kim SH, Jo M, Choi YS. Pulse pressure variation and pleth variability index as predictors of fluid responsiveness in patients undergoing spinal surgery in the prone position. Ther Clin Risk Manag. 2018 ;14:1175-83.
• Referans3) Coeckelenbergh S, Delaporte A, Ghoundiwal D, Bidgoli J, Fils JF, Schmartz D et al. Pleth variability index versus pulse pressure variation for intraoperative goal-directed fluid therapy in patients undergoing low-to-moderate risk abdominal surgery: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):34
• Referans4) Maughan BC, Seigel TA, Napoli AM. Pleth variability index and fluid responsiveness of hemodynamically stable patients after cardiothoracic surgery. Am J Crit Care. 2015;24(2):172-5.
• Referans5) Dache S, Van Rompaey N, Joosten A, Desebbe O, Saxena S, Eynden FV et al. Comparison of the ability of esCCO and Volume View to measure trends in cardiac output in patients undergoing cardiac surgery. Anaesthesiol Intensive Ther. 2017;49(3):175-80
• Referans6) David JW Knight, MRCP FRCA, Ravi P Mahajan, DM FRCA. Patient positioning in anaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. 2004;5(4):160–63
• Referans7) Nakajima Y, Mizobe T, Matsukawa T. Thermoregulatory response to intraoperative head-down tilt. Anesth analg. 2002;94(1):221-6
• Referans8) Summers RL, Thompson JR, Hoodward LH, Martin DS. Physiologic mechanisms associated with the Trendelenburg Position Am J Clin Med. 2009;(6):24-7
• Referans9) Edgcombe H., Carter K., Yarrow S. Anaesthesia in the prone position. BJA. 2008; 100 (2): 165–83
• Referans10) Keller G, Cassar E, Desebbe O, Lehot JJ, Cannesson M. Ability of pleth variability index to detect hemodynamic changes induced by passive leg raising in spontaneously breathing volunteers. Crit Care. 2008;12(2):R37
• Referans11) Huang HS, Chu CL, Tsai CT, Wu CK, Lai LP, Yeh HM. Perfusion index derived from a pulse oximeter can detect changes in peripheral microcirculation during uretero-renal-scopy stone manipulation (URS-SM). PLoS One. 2014 ;9(12):e115743
• Referans12) Godai K, Matsunaga A, Kanmura Y. The effects of hemodynamic management using the trend of the perfusion index and pulse pressure variation on tissue perfusion: a randomized pilot study. JA Clin Rep. 2019 ;5(1):72.
• Referans13) Chu H, Wang Y, Sun Y, Wang G. Accuracy of pleth variability index to predict fluid responsiveness in mechanically ventilated patients: a systematic review and metaanalysis. J Clin Monit Comput 2016;30(3):265–74
• Referans14) Sun S, Huang SQ. Role of pleth variability index for predicting hypotension after spinal anesthesia for cesarean section. Int J Obstet Anesth 2014; 23: 324-9
• Referans15) De Backer D, Pinsky MR. Can one predict fluid responsiveness in spontaneously breathing patients? Intensive Care Med 2007;33:1111–3
• Referans16) Demirci OL, Çıkrıkçı Işık G, Çorbacıoğlu ŞK, Çevik Y. Comparing Pleth variability index (PVI) variation induced by passive leg raising and Trendelenburg position in healthy volunteers. Am J Emerg Med. 2019 May 7. doi: 10.1016/j.ajem.2019.05.015. [Epub ahead of print]
• Referans17) Vincent JL, Rhodes A, Perel A, Martin GS, Della Rocca G, Vallet B, et al. Clinical review: Update on hemodynamic monitoring—a consensus of 16. Crit Care. 2011;15(4):229
• Referans18) Suzuki T, Suzuki Y, Okuda J, Minoshima R, Misonoo Y, Ueda T, et al. Cardiac output and stroke volume variation measured by the pulse wave transit time method: a comparison with an arterial pressure-based cardiac output system. J Clin Monit Comput. 2019;33(3):385-92.
• Referans19) Terada T, Oiwa A, Maemura Y, Robert S, Kessoku S, Ochiai R. Comparison of the ability of two continuous cardiac output monitors to measure trends in cardiac output: estimated continuous cardiac output measured by modified pulse wave transit time and an arterial pulse contour-based cardiac output device. J Clin Monit Comput. 2016 ;30(5):621-7