Abstract
Background: Timely identification of hemodynamic compromise in patients with acute pericardial effusion and tamponade is critical in patient management. Respiratory variability in pulse‐oximetry waveforms has been correlated with pulsus paradoxus, but has not been reported with cardiac tamponade in adult patients.
Hypothesis: This study describes changes in respiratory variability in pulse‐oximetry waveform pre and post pericardiocentesis in patients with hemodynamically significant pericardial effusions.
Methods: A single‐center, catheterization laboratory hemodynamic database was reviewed for all patients who underwent pericardiocentesis for clinically suspected tamponade and had continuous digital pulse‐oximetry, electrocardiographic, and respiration waveforms recorded during the procedure. Phasic respiratory changes in pulse‐oximetry waveform amplitude (maxima‐minima) were expressed as an expiratory/inspirato‐ry ratio and compared pre and post pericardiocentesis.
Results: The study population consisted of 12 patients (6 men:6 women, age 60 ± 10 years) with pericardial effusion documented by echocardiography on the day of pericardiocentesis. Phasic respiratory variability in the pulse‐oximetry waveform was evident in all patients prior to aspiration (respiratory ratio = 1.9 ± 0.5). Following pericardiocentesis (aspirated volume: 650 ±300 ml), the respiratory ratio decreased in all patients (1.2 ± 0.1, p = 0.001). Receiver operator characteristic curve analysis suggests that pulse‐oximetry respiratory ratios > 1.5 should raise suspicion of hemodynamic compromise in high‐risk populations.
Conclusions: Pulse‐oximetry is a commonly used tool for monitoring critically ill patients. The present study suggests that increased respiratory variability in the pulse‐oximetry waveform should raise suspicion for hemodynamic compromise in patients at risk for pericardial effusion.
Keywords: pulse oximetry, cardiac tamponade, pericardial effusion
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