Systolic blood pressure at end-expiration measured by the automated systolic pressure variation monitor is equivalent to systolic blood pressure during apnea

Objective. It is necessary to define a reference systolic arterial blood pr essure (RP) to calculate delta-Up (dUp) and delta-Down (dDown) for systolic pressure variation. Most studies define the reference pressure as the aver age systolic blood pressure during a short period of apnea. We describe an automated systolic pressure variation monitor that measures airway pressure and defines the reference pressure as the systolic blood pressure at end-e xpiration. The present study compares the reference systolic blood pressure measured at end-expiration by the automated systolic pressure variation mo nitor and the reference systolic blood pressure measured during apnea to te st whether the end-expiration value is an adequate substitute for the value during apnea. Methods. After obtaining informed consent, 108 sets of measu rements of systolic pressure variation (SPV) were made in 20 intubated, mec hanically-ventilated, anesthetized patients by the automated SPV monitor an d during apnea. Measurements were taken during periods of hemodynamic stabi lity defined as three consecutive end-expiratory systolic blood pressures w ithin four mmHg of each other. The three systolic pressures at end-expirati on were averaged (RPmonitor). Immediately following these measurements, the ventilator was turned off and the systolic blood pressure was measured at 6, 8, 10 and 12 seconds of apnea. The reference pressure during apnea (RPap nea) was defined as the average of the systolic blood pressure at 8, 10 and 12 seconds of apnea. For each measurement set, RPmonitor and the systolic blood pressure at 6 seconds of apnea (SBP6) were compared to RPapnea using Bland-Altman analysis. Results. Bland-Altman analysis for the difference be tween SBP6 and RPapnea yielded a small bias of -0.3 mmHg with standard devi ation of 1.3, indicating that the systolic pressure tends to continue to in crease slightly after 6 seconds of apnea. Results were similar for the diff erence between RPmonitor and RPapnea (-0.2 +/- 3.1 mmHg). Conclusions. dUp and dDown are calculated using the reference pressure. RPmonitor is an aver age of 0.2 mm Hg less than RPapnea, thus dUp calculated by the automated SP V monitor is an average of 0.2 mm Hg greater than dUp measured by the refer ence pressure during apnea and dDown is 0.2 mm Hg less. Since the bias of - 0.2 mmHg is clinically insignificant, there is acceptable agreement between the reference pressure obtained during apnea and that obtained by the auto mated SPV monitor at end-expiration. The mean difference between RPmonitor and RPapnea is explained by the continued rise in systolic pressure during the period of apnea as demonstrated by the difference between SBP6 and RPap nea.