Continuous Noninvasive Measurement of Pulsus Paradoxus Complements Medical Decision Making in Assessment of Acute Asthma Severity: Conclusion
Like other vital signs, PP offers the opportunity to follow disease progression and the response to therapy. As a unique pathophysiologic vital sign, PP can also be used as a screening vital sign in patients with undifferentiated dyspnea. The rapid evaluation for PP in ED triage could drive the differentiation of subjective dyspnea in the ED patient population. As a group, patients with dyspnea occupy 20% of this patient population. However, only those patients with asthma, pericardial effusions or tamponade, massive pulmonary embolus, tension pneumotho-rax, and severe dehydration will manifest PP. Patients with silent chest asthma could be more readily identified during triage evaluation. Continuous PP monitoring also offers the opportunity to assess the response of asthma and croup to pharmacotherapy. This will also be important in evaluating new products for the management of both diseases, as PP has been used in previous pharmacologic trials. It may also become possible to remotely monitor asthma severity via continuous PP, which would benefit many patients with a well-established diagnosis. Monitoring patients in this way could avoid unnecessary ED visits and hospitalizations, which account for the largest proportion of asthma care costs. Finally, continuous PP monitoring would add a new dimension in the identification of obstructive sleep apnea by identifying upper glottis closure and pathophysiologic dyscrasias before hypoxia occurs among patients undergoing sleep studies. buy zoloft cheap
The AT-PP detection algorithm for continuous BP monitoring used in this study was accurate and precise, meeting the Association for the Advancement of Medical Instrumentation tolerance requirements for medical devices. This algorithm should also be transferable to other continuous and nonin-vasive BP monitors. In the event that continuous noninvasive BP monitoring becomes more available in acute care settings, we believe that PP could replace PEFR as the preferred metric of acute asthma severity. PEFR alone appears to be unpre-dictive of patient outcome in patients with acute asthma and is no longer recommended by the American College of Emergency Physicians. In a study of acute asthma in pediatric patients, PP appeared to be a surrogate for spirometry in evaluating asthma severity. Finally, PEFR meters, which are manufactured by a number of different companies, appear to have variable accuracy. Despite these and other limitations, PEFR is widely used by patients as it appears to be superior to symptom self-monitoring and occupies a niche in monitoring asthmatic patients on an ongoing basis. However, the practice of having acutely dyspneic patients perform forcible expiratory maneuvers is also not without risk.