Pleth Variability and Asthma Severity in Children
| Status: | Completed |
|---|---|
| Conditions: | Asthma |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | Any - 17 |
| Updated: | 7/27/2016 |
| Start Date: | January 2015 |
| End Date: | July 2016 |
Using Pleth Variability to Triage Asthmatics in the Pediatric ED
Research has shown that pleth variability can be used to assess asthma severity in children
with status asthmaticus. The investigators would like to use an FDA-cleared monitor (Masimo
Radical 7) which measures Pleth Variability Index (PVI) to see if the degree of PVI can be
used to help triage patients who present to the pediatric ED in status asthmaticus.
with status asthmaticus. The investigators would like to use an FDA-cleared monitor (Masimo
Radical 7) which measures Pleth Variability Index (PVI) to see if the degree of PVI can be
used to help triage patients who present to the pediatric ED in status asthmaticus.
Patients with asthma have obstruction to exhalation resulting in hyperinflation of their
lungs. This hyperinflation results in a phenomenon known as pulsus paradoxus in which the
physiologic drop in blood pressure normally seen with inhalation is exaggerated. Studies
have shown that patients with more severe asthma exacerbations (i.e. more hyperinflation)
have a greater degree of pulsus paradoxus. Typically, pulsus paradoxus is measured using a
sphygmomanometer, however, researchers have demonstrated that it can also accurately be
measured using plethysmography, a term known as pleth variability index (PVI). Using this
concept, Arnold et al (2008, 2010) showed that a greater degree of pulsus paradoxus
correlates with asthma severity.
The investigators' study aims to simplify the association between PVI and asthma severity.
The investigators hypothesize the following:
1. Patients with a higher admission PVI will have a higher likelihood of being admitted to
the hospital.
2. Patients admitted to the Intensive Care Unit (PICU) will have a higher PVI than
patients admitted to a floor.
3. PVI can be accurately used to gauge response to bronchodilator/anti-inflammatory
therapy.
4. PVI is as effective as respiratory severity score in predicting asthma severity and in
gauging response to bronchodilator therapy.
To do this the investigators will recruit children who present to the pediatric ED in status
asthmaticus. They will be connected to a Masimo Radical 7 monitor upon admission to the ED
and then again 4 hours later. In addition the investigators will calculate respiratory
severity scores at those same time intervals. The investigators will then look at the
disposition of the patient upon leaving the ED: discharge to home, admission to an inpatient
floor or admission to the ICU.
lungs. This hyperinflation results in a phenomenon known as pulsus paradoxus in which the
physiologic drop in blood pressure normally seen with inhalation is exaggerated. Studies
have shown that patients with more severe asthma exacerbations (i.e. more hyperinflation)
have a greater degree of pulsus paradoxus. Typically, pulsus paradoxus is measured using a
sphygmomanometer, however, researchers have demonstrated that it can also accurately be
measured using plethysmography, a term known as pleth variability index (PVI). Using this
concept, Arnold et al (2008, 2010) showed that a greater degree of pulsus paradoxus
correlates with asthma severity.
The investigators' study aims to simplify the association between PVI and asthma severity.
The investigators hypothesize the following:
1. Patients with a higher admission PVI will have a higher likelihood of being admitted to
the hospital.
2. Patients admitted to the Intensive Care Unit (PICU) will have a higher PVI than
patients admitted to a floor.
3. PVI can be accurately used to gauge response to bronchodilator/anti-inflammatory
therapy.
4. PVI is as effective as respiratory severity score in predicting asthma severity and in
gauging response to bronchodilator therapy.
To do this the investigators will recruit children who present to the pediatric ED in status
asthmaticus. They will be connected to a Masimo Radical 7 monitor upon admission to the ED
and then again 4 hours later. In addition the investigators will calculate respiratory
severity scores at those same time intervals. The investigators will then look at the
disposition of the patient upon leaving the ED: discharge to home, admission to an inpatient
floor or admission to the ICU.
Inclusion Criteria:
- Diagnosis of asthma or reactive airway disease upon leaving the ED
- Greater than 10 kg
Exclusion Criteria:
- Patients in whom effective pulse oximetry tracings cannot be obtained
- Patients who are diagnosed with conditions other than asthma/reactive airway disease
that are known to cause pulsus paradoxus
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