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Pulse Oximetry for Assessment of Pulsus Paradoxus Pulse Oximetry for Assessment of Pulsus Paradoxus FREE TO VIEW

Bernhard Frey, MD
Author and Funding Information

Affiliations: Ostschweizer Kinderspital, St. Gallen, Switzerland ,  Vanderbilt University School of Medicine, Nashville, TN

Correspondence to: Bernhard Frey, MD, Intensivpflegestation, Ostschweizer Kinderspital, CH-9006 St. Gallen, Switzerland; e-mail: bernhard.frey@bluewin.ch



Chest. 1999;116(5):1491-1492. doi:10.1378/chest.116.5.1491-a
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To the Editor:

We read with interest the study of Hartert et al (February 1999)1on the use of pulse oximetry for assessing pulsus paradoxus. We performed a very similar study in children,2 notably with the same brand of pulse oximeter, and gained the same results: there is a close association between pulsus paradoxus (in our study, measured by intra-arterial pressure monitoring) and the fluctuations of the plethysmographic respiratory wave (r = 0.85; 95% confidence interval, 0.76 to 0.91). Hartert et al1 made an important contribution toward the routine application of pulse oximetry by working out the technical basis of the phenomenon. Obviously, this phenomenon is not restricted to a single device. The authors documented their observations in four different monitoring systems. After calibration of the device, which entails a specific association between the number of millimeters of change in the plethysmographic baseline and the number of millimeters of Hg recording pulsus paradoxus, electronic analysis of the plethysmographic fluctuations can show a continuous measurement of pulsus paradoxus.

About half of the patients studied by Hartert et al1 were receiving mechanical ventilation. The authors did not mention that in patients receiving positive-pressure ventilation the lowest BP values are recorded during expiration (reversed pulsus paradoxus), whereas in spontaneous breathing they are recorded during inspiration. The correlation between pulsus paradoxus and pulse oximetry in tracing fluctuations might not be influenced by the state of respiration (spontaneous or mechanical ventilation). However, (reversed) pulsus paradoxus might not be a good parameter of disease severity in patients receiving mechanical ventilation, as the magnitude of pulsus paradoxus depends at least partly on the applied ventilator pressures.3

Hartert, TV, Wheeler, AP, Sheller, JR (1999) Use of pulse oximetry to recognize severity of airflow obstruction in obstructive airway disease: correlation with pulsus paradoxus.Chest115,475-481. [CrossRef]
 
Frey, B, Butt, W Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children.Intensive Care Med1998;24,242-246. [CrossRef]
 
Jardin, F, Farcot, JC, Gueret, P, et al Cyclic changes in arterial pulse during respiratory support.Circulation1983;68,266-274. [CrossRef]
 

Pulse Oximetry for Assessment of Pulsus Paradoxus

To the Editor:

I thank Dr. Frey for his thoughts and comments in regard to our study of the use of pulse oximetry in assessing pulsus paradoxus (February 1999).1The confirmation of our study by his series2 in children is important in validating pulse oximetry as a useful tool in individuals who are critically ill. In regard to our utilization of the respiratory waveform variation in persons receiving mechanical ventilation, I concur that there are limitations. However, I feel that this finding is useful even in those patients receiving mechanical ventilation as it suggests that either the applied ventilator pressures or the work of breathing are such that they impact the inspiratory fall in systolic BP.

I apologize for not having referenced the work of Frey and Butt2 in our manuscript, and thanks to Dr. Frey once again for his thoughtful comments.

References
Hartert, TV, Wheeler, AP, Sheller, JR Use of pulse oximetry to recognize severity of airflow obstruction in obstructive airway disease: correlation with pulsus paradoxus.Chest1999;115,475-481. [CrossRef]
 
Frey, B, Butt, W Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children.Intensive Care Med1998;24,242-246. [CrossRef]
 

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References

Hartert, TV, Wheeler, AP, Sheller, JR (1999) Use of pulse oximetry to recognize severity of airflow obstruction in obstructive airway disease: correlation with pulsus paradoxus.Chest115,475-481. [CrossRef]
 
Frey, B, Butt, W Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children.Intensive Care Med1998;24,242-246. [CrossRef]
 
Jardin, F, Farcot, JC, Gueret, P, et al Cyclic changes in arterial pulse during respiratory support.Circulation1983;68,266-274. [CrossRef]
 
Hartert, TV, Wheeler, AP, Sheller, JR Use of pulse oximetry to recognize severity of airflow obstruction in obstructive airway disease: correlation with pulsus paradoxus.Chest1999;115,475-481. [CrossRef]
 
Frey, B, Butt, W Pulse oximetry for assessment of pulsus paradoxus: a clinical study in children.Intensive Care Med1998;24,242-246. [CrossRef]
 
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