Preprint: Please note that this article has not completed peer review.
Research article

Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients.

Mohamed Shaban, Ahmed Hasanin, Akram El-adawy, Hanan Mostafa, Shymaa Fathy, Hossam M Abdelreheem, Ahmed Lotfy, Ayman Abougabal, Hassan Mohamed, Ahmed Mukhtar
DOI: 10.21203/rs.2.9492/v2

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 minutes before the hemodialysis session, 15 minutes before the start of hemodialysis session, every 5 minutes during the session, and 15 minutes 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.

Keywords
Intradialytic hypotension – peripheral perfusion index – heart rate variability

Figures

Introduction

Patients and Methods

Results

Discussion

Conclusions

List of abbreviations

Declarations

References

Tables

STATUS: In Review

Comments: 0
PDF Downloads: 0
HTML Views: 41

Integrity Check:

Peer Review Timeline

Version 2

Posted 13 Aug, 2019

  • No community comments so far
  • Reviewer #1 agreed

    On 07 Aug, 2019

  • 1 reviewer(s) invited

    Invitations sent on 01 Aug, 2019

  • Editor assigned

    On 31 Jul, 2019

  • Submission checks complete

    On 30 Jul, 2019

  • Editor invited

    On 30 Jul, 2019

Version 1

Posted 07 May, 2019

View this version

Subject Areas

Internal Medicine

More from BMC Anesthesiology

Comments (0)

Comments can take the form of short reviews, notes or questions to the author. Comments will be posted immediately, but removed and moderated if flagged.

Learn more about our company.

Preprint: Please note that this article has not completed peer review.
Research article

Evaluation of peripheral perfusion index and heart rate variability as early predictors for intradialytic hypotension in critically ill patients.

Mohamed Shaban, Ahmed Hasanin, Akram El-adawy, Hanan Mostafa, Shymaa Fathy, Hossam M Abdelreheem, Ahmed Lotfy, Ayman Abougabal, Hassan Mohamed, Ahmed Mukhtar

STATUS: In Review

Comments: 0
PDF Downloads: 0
HTML Views: 41

Integrity Check:

  • Article

  • Peer Review Timeline

  • Related Articles

  • Comments

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 minutes before the hemodialysis session, 15 minutes before the start of hemodialysis session, every 5 minutes during the session, and 15 minutes 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.

Figures

Introduction

Patients and Methods

Results

Discussion

Conclusions

List of abbreviations

Declarations

References

Tables