Respiratory changes in the pulse-oximetry waveform associated with pericardial tamponade

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/inspiratory 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.