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A new photoplethysmographic device for continuous assessment of urethral mucosa perfusion: evaluation in a porcine model

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Abstract

This study proposes to evaluate an innovative device consisting of an indwelling urinary catheter equipped with a photoplethysmography (PPG) sensor in contact with the urethral mucosa that provides a continuous index called urethral perfusion index (uPI). The goal of this study was to determine if the uPI could bring out tissue perfusion modifications induced by hypotension and vasopressors in a porcine model. Twelve piglets were equipped for heart rate, MAP, cardiac index, stroke volume index, systemic vascular resistance index and uPI monitoring. The animals were exposed to different levels of mean arterial pressure (MAP), ranging from low to high values. Friedman tests with a posteriori multiple comparison were performed and a generalized linear mixed model (GLMM) was used to assess the relationship between uPI and MAP. Urethral Perfusion Index and other haemodynamic parameters varied significantly at the different time-points of interest. There was a positive correlation between MAP and uPI below a specific MAP value, called dissociation threshold (DT). Above this threshold, uPI and MAP were negatively correlated. This relationship, assessed with the GLMM, yielded a significant positive fixed effect coefficient (+ 0.2, P < 0.00001) below the DT and a significant negative fixed effect (− 0.14, P < 0.00001) above DT. In an experimental setting, the PPG device and its index uPI permitted the detection of urethral mucosa perfusion alterations associated with hypotension or excessive doses of vasopressors. Further studies are needed to evaluate this device in a clinical context.

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Data Availability

All data generated or analysed during this study are included in this published article.

Abbreviations

AC:

Alternate current

CI:

Cardiac index

CRI:

Intravenous constant rate infusion

DAP:

Diastolic arterial pressure

DC:

Direct current

DT:

Dissociation threshold

GLMM:

Generalized linear mixed model

HR:

Heart rate,

IM:

Intramuscular

IV:

Intravenous

MAC:

Minimal alveolar concentration

MAP:

Mean arterial pressure

NE:

Norepinephrine

PPG:

Photoplethysmography

PPV:

Pulse pressure variation

SAP:

Systolic arterial pressure

SVI:

Stroke volume index,

SVRI:

Systemic vascular resistance index,

SVV:

Stroke volume variation,

uPI:

Urethral perfusion index

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Acknowledgements

Rémi Bonidal, Benjamin Delcroix and Dominique Falcon (Advanced Perfusion Diagnostics) for their technical support.

Funding

Funded research by APD (funds covered the material, the animals, the location of the veterinary operative room, the drugs and surgical and anaesthetic materials). APD did not take part in collection, analysis and interpretation of neither in the data or the writing of the manuscript. There was no clause of publication in the contract between our institution and APD.

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Authors and Affiliations

  1. VetAgro Sup, Université de Lyon, Unité APCSe, Campus Vétérinaire de Lyon, 1 Avenue Bourgelat, 69280, Marcy l’Etoile, France

    Martina Cardinali, Mathieu Magnin, Jeanne-Marie Bonnet-Garin, Christian Paquet, Jean-Yves Ayoub & Stephane Junot

  2. Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Réanimation Médicale, Université Claude Bernard Lyon 1, Unité APCSe, 5 place d’Arsonval, 69437, Lyon, Cedex 03, France

    Bernard Allaouchiche

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  1. Martina Cardinali
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Contributions

The first draft of the manuscript was written by MC. MC, MM, CP, J-YA and SJ performed the experimentation and data collection. SJ designed the study and performed the statistical analysis and helped to draft the manuscript. JB and BA contributed to the study design and coordination and helped to draft the manuscript. MM, CP, J-YA also revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephane Junot.

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Conflicts of interest

B. Allaouchiche: Consultant for APD, The other authors declare that they have no conflict of interest.

Ethics approval

The study was approved by our local ethical board for animal research and care (Vet Agro Sup, Marcy l’Etoile, France, authorization number: 1819) in accordance with European regulations (Directive 2010/63/EU).

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Cardinali, M., Magnin, M., Bonnet-Garin, JM. et al. A new photoplethysmographic device for continuous assessment of urethral mucosa perfusion: evaluation in a porcine model. J Clin Monit Comput 35, 585–598 (2021). https://doi.org/10.1007/s10877-020-00515-w

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