Delta down compared with delta pulse pressure as an indicator of volaemia during intracranial surgery E. Deflandre, V. Bonhomme, P. Hans British Journal.

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Presentation transcript:

Delta down compared with delta pulse pressure as an indicator of volaemia during intracranial surgery E. Deflandre, V. Bonhomme, P. Hans British Journal of Anaesthesia Volume 100, Issue 2, Pages 245-250 (February 2008) DOI: 10.1093/bja/aem361 Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 1 Illustration of the DPP measurement. First line represents the upper airway pressure and the second line represents the invasive arterial pressure. DPP, delta pulse pressure; PP, pulse pressure. Equation is explained in the text. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 2 Illustration of the Delta up and DD measurements. First line represents the upper airway pressure and the second line represents the invasive arterial pressure. Explanations can be found in the text. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 3 Relationship between DD and DPP. The regression line between them and its equation are displayed. Grey lines indicate the thresholds of DPP (13%) and DD (5 mm Hg). British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 4 ROC curve of DD for discriminating patients with a DPP value higher or lower than 13%. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 5 Logistic regression between DD and the probability of DPP being higher than 13%. The equation of the regression curve is logit(P)=−12.661+2.318×DD, where logit(P)=log [P/(1−P)], and P, probability of DPP being higher than 13%. The DD value associated with a 50% probability is 5.4. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 6 Flow chart of DPP measurements having led to a fluid loading. Out of the 802 paired measurements of DPP and DD, two consecutive measures of DPP>13% were observed 41 times, leading to FL. The corresponding DD were >5 mm Hg. FL resulted in a decrease of DPP below 13% 40 times and in a decrease of DD below 5 mm Hg 41 times. A single value of DPP>13% was observed 16 times. Among those, DD was >5 mm Hg six times, the following measure of DD being <5 mm Hg 10 min later. Simultaneous observation of a DPP<13% and DD>5 mm Hg occurred on four occasions. In three of those observations, the two following measurements of DPP gave values >13% and led to FL. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions

Fig 7 Cumulative incidence of FL as a function of time after radial catheter insertion. The incidence is the number of FL per patient per hour of observation, that is, per five paired consecutive measures of DPP. British Journal of Anaesthesia 2008 100, 245-250DOI: (10.1093/bja/aem361) Copyright © 2008 British Journal of Anaesthesia Terms and Conditions