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Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation

1
Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Korea
2
Departments of Anesthesiology and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(5), 717; https://doi.org/10.3390/jcm8050717
Received: 12 March 2019 / Revised: 14 May 2019 / Accepted: 17 May 2019 / Published: 20 May 2019
(This article belongs to the Section Anesthesiology)
The aim of this study was to analyze whether the respiratory variation in electrocardiogram (ECG) standard lead II R-wave amplitude (ΔRDII) could be used to assess intravascular volume status following inferior vena cava (IVC) clamping. This clamping causes an acute decrease in cardiac output during liver transplantation (LT). We retrospectively compared ΔRDII and related variables before and after IVC clamping in 34 recipients. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to derive a cutoff value of ΔRDII for predicting pulse pressure variation (PPV). After IVC clamping, cardiac output significantly decreased while ΔRDII significantly increased (p = 0.002). The cutoff value of ΔRDII for predicting a PPV >13% was 16.9% (AUC: 0.685) with a sensitivity of 57.9% and specificity of 77.6% (95% confidence interval 0.561 – 0.793, p = 0.015). Frequency analysis of ECG also significantly increased in the respiratory frequency band (p = 0.016). Although significant changes in ΔRDII during vena cava clamping were found at norepinephrine doses <0.1 µg/kg/min (p = 0.032), such changes were not significant at norepinephrine doses >0.1 µg/kg/min (p = 0.093). ΔRDII could be a noninvasive dynamic parameter in LT recipients presenting with hemodynamic fluctuation. Based on our data, we recommended cautious interpretation of ΔRDII may be requisite according to vasopressor administration status. View Full-Text
Keywords: Brody effect; electrocardiographic variation; R-wave amplitude; hemodynamic monitoring; pulse pressure variation Brody effect; electrocardiographic variation; R-wave amplitude; hemodynamic monitoring; pulse pressure variation
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MDPI and ACS Style

Park, H.-S.; Kim, S.-H.; Park, Y.-S.; Thiele, R.H.; Shin, W.-J.; Hwang, G.-S. Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation. J. Clin. Med. 2019, 8, 717.

AMA Style

Park H-S, Kim S-H, Park Y-S, Thiele RH, Shin W-J, Hwang G-S. Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation. Journal of Clinical Medicine. 2019; 8(5):717.

Chicago/Turabian Style

Park, Hee-Sun; Kim, Sung-Hoon; Park, Yong-Seok; Thiele, Robert H.; Shin, Won-Jung; Hwang, Gyu-Sam. 2019. "Respiratory Variations in Electrocardiographic R-Wave Amplitude during Acute Hypovolemia Induced by Inferior Vena Cava Clamping in Patients Undergoing Liver Transplantation" J. Clin. Med. 8, no. 5: 717.

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