Pulse Oximeter Plethysmograph Estimate of Pulsus Paradoxus as a Measure of Acute Asthma Exacerbation Severity and Response to Treatment.
Pulse Oximeter Plethysmograph Estimate of Pulsus Paradoxus as a Measure of Acute Asthma Exacerbation Severity and Response to Treatment.
复制标题
脉搏血氧计体积描记器估计奇异脉作为哮喘急性发作严重程度和治疗反应的衡量标准。
DOI：
10.1111/acem.12886
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Hartert,TinaV
中科院分区：
文献类型：
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作者：
Arnold,DonaldH;Wang,Li;Hartert,TinaV
目的脉搏反常是衡量急性哮喘加重程度的少数客观床边指标之一，但在呼吸急促、心动过速患者以及在嘈杂的临床环境中很难测量。我们的主要目的是检查脉搏血氧饱和度(PEP)的体积描记评估是否与急性加重严重程度的生理和症状测量(脉冲振荡法的气道阻力[%IOS]和急性哮喘强度研究评分[AAIRS])相关。次要目标是验证先前PEP与预计1秒用力呼气容积百分比(%FEV1)的相关性，并检查PEP的变化与治疗2小时后这些结果变化的相关性。方法这是对5-17岁哮喘急性发作患者的前瞻性观察研究数据的二次分析。使用专用脉搏血氧仪和波形分析程序测量预测变量PEP。结果测量包括基线和治疗2小时后的AAIRS、%IOS和%FEV1。我们使用调整了年龄、性别和种族的多元线性回归模型，检验了基线时PEP与%IOS和AAIRS的相关性。结果：在684名参与者(684名男性，61%非裔美国人)中，基线PEP与%IOS、AAIR和%FEV1(p<；0.001)有关联。治疗2小时后PEP的变化与%FEV1(P<0.001.0 1)和AAIR的变化(P=0.0 1)相关，而与%IOS的变化无关(P=0.6 0)。结论PEP在预测基线%IOS、AAIR和%FEV1，以及对AAIR和%FEV1变化的反应性方面具有一定的效度。血氧计体积图波形中包含的数据可用作急性哮喘恶化严重程度和对治疗的实时反应的连续、客观的测量。
ObjectivesPulsus paradoxus is one of the few objective bedside measures of acute asthma exacerbation severity but is difficult to measure in tachypneic and tachycardic patients and in noisy clinical environments. Our primary objective was to examine whether pulse oximeter plethysmograph estimate of pulsus paradoxus (PEP) is associated with physiologic and symptom measures of acute exacerbation severity (airway resistance by impulse oscillometry [%IOS] and the Acute Asthma Intensity Research Score [AAIRS]). Secondary objectives were to validate the previous association of PEP with percent predicted forced expiratory volume in 1 second (%FEV1) and to examine associations of change of PEP with change of these outcomes after 2 hours of treatment.MethodsThis was a secondary analysis of data from a prospective observational study of patients aged 5–17 years with acute asthma exacerbations. The predictor variable, PEP, was measured using a dedicated pulse oximeter and waveform analysis program. Outcome measures included the AAIRS, %IOS, and %FEV1at baseline and after 2 hours of treatment. We examined associations of PEP with %IOS and the AAIRS at baseline using multiple linear regression models adjusted for age, sex, and race. As secondary analyses we similarly examined the association of PEP with %FEV1at baseline and change of PEP with change of %IOS, the AAIRS, and %FEV1after 2 hours of treatment using multiple linear regression models adjusted for the baseline value of the outcome measure and the AAIRS.ResultsAmong 684 participants (61% males; 61% African American) there were associations of baseline PEP with %IOS, the AAIRS, and %FEV1(p < 0.001). Change of PEP after 2 hours of treatment was associated with change of %FEV1(p < 0.001) and change of the AAIRS (p = 0.01) but not with change of %IOS (p = 0.60).ConclusionsPEP demonstrates criterion validity in predicting baseline %IOS, the AAIRS, and %FEV1, and responsiveness to change of the AAIRS and %FEV1. Data contained in the oximeter plethysmograph waveform might be utilized as a continuous, objective measure of acute asthma exacerbation severity and real‐time response to treatment.