Abstract
Arterial blood pressure and cardiac output are the two most important and frequently measured hemodynamic parameters in critically ill patients as they provide indirect information on global tissue perfusion and oxygen delivery, and can guide fluid management and vasoactive drug use [1, 2]. Inaccurate measurement of these parameters, both in the intensive care unit (ICU) and the operating room (OR), can lead to misdiagnosis and inappropriate treatment, potentially impacting on patient morbidity and mortality. In the ICU, arterial blood pressure is commonly measured invasively via a peripheral artery (e.g., radial) or less frequently via a central artery (e.g., femoral). However, because the arterial blood pressure is not constant throughout the arterial tree — as a consequence of changes in hydrostatic pressure, arterial stiffness, and pressure wave reflection that are dependent on individual characteristics (e.g., age, height, gender), disease state (e.g., sepsis), and the administration of vasoactive drugs — the site of arterial blood pressure measurement may not faithfully reflect organ perfusion pressure.
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References
Pinsky MR (2002) Functional hemodynamic monitoring. Intensive Care Med 28: 386–388
Hofer CK, Ganter MT, Zollinger A (2007) What technique should I use to measure cardiac output? Curr Opin Crit Care 13: 308–317
Cholley BP, Payen D (2005) Noninvasive techniques for measurements of cardiac output. Curr Opin Crit Care 11: 424–429
Berton C, Cholley B (2002) Equipment review: new techniques for cardiac output measurement — oesophageal Doppler, Fick principle using carbon dioxide, and pulse contour analysis. Crit Care 6: 216–221
Della Rocca G, Costa MG (2005) Volumetric monitoring: principles of application. Minerva Anestesiol 71: 303–306
Rodig G, Prasser C, Keyl C, Liebold A, Hobbhahn J (1999) Continuous cardiac output measurement: pulse contour analysis vs thermodilution technique in cardiac surgical patients. Br J Anaesth 82: 525–530
Tannenbaum GA, Mathews D, Weissman C (1993) Pulse contour cardiac output in surgical intensive care unit patients. J Clin Anesth 5: 471–478
Weissman C, Ornstein EJ, Young WL (1993) Arterial pulse contour analysis trending of cardiac output: hemodynamic manipulations during cerebral arteriovenous malformation resection. J Clin Monit 9: 347–353
Gratz I, Kraidin J, Jacobi AG, de Castro NG, Spagna P, Larijani GE (1992) Continuous noninvasive cardiac output as estimated from the pulse contour curve. J Clin Monit 8: 20–27
Linton NW, Linton RA (2001) Estimation of changes in cardiac output from the arterial blood pressure waveform in the upper limb. Br J Anaesth 86: 486–496
Jansen JR, Wesseling KH, Settels JJ, Schreuder JJ (1990) Continuous cardiac output monitoring by pulse contour during cardiac surgery. Eur Heart J 11 (Suppl I):26–32
Godje O, Hoke K, Goetz AE, et al (2002) Reliability of a new algorithm for continuous cardiac output determination by pulse-contour analysis during hemodynamic instability. Crit Care Med 30: 52–58
Band DM, Linton RA, O’Brien TK, Jonas MM, Linton NW (1997) The shape of indicator dilution curves used for cardiac output measurement in man. J Physiol 498 (Pt 1): 225–229
Linton RA, Band DM, Haire KM (1993) A new method of measuring cardiac output in man using lithium dilution. Br J Anaesth 71: 262–266
Linton R, Band D, O’Brien T, Jonas M, Leach R (1997) Lithium dilution cardiac output measurement: a comparison with thermodilution. Crit Care Med 25: 1796–1800
O’Rourke MF, Seward JB (2006) Central arterial pressure and arterial pressure pulse: new views entering the second century after Korotkov. Mayo Clin Proc 81: 1057–1068
Pauca AL, Wallenhaupt SL, Kon ND, Tucker WY (1992) Does radial artery pressure accurately reflect aortic pressure? Chest 102: 1193–1198
Hirata K, Kawakami M, O’Rourke MF (2006) Pulse wave analysis and pulse wave velocity: a review of blood pressure interpretation 100 years after Korotkov. Circ J 70: 1231–1239
Nichols WW, O’Rourke MF (2005) McDonald’s Blood Flow in Arteries, Fifth edn. Hodder Arnold, London
O’Rourke MF, Blazek JV, Morreels CL Jr, Krovetz LJ (1968) Pressure wave transmission along the human aorta. Changes with age and in arterial degenerative disease. Circ Res 23: 567–579
Kelly RP, Gibbs HH, O’Rourke MF, et al (1990) Nitroglycerin has more favourable effects on left ventricular afterload than apparent from measurement of pressure in a peripheral artery. Eur Heart J 11: 138–144
Slogoff S, Keats AS, Arlund C (1983) On the safety of radial artery cannulation. Anesthesiology 59: 42–47
Soderstrom CA, Wasserman DH, Dunham CM, Caplan ES, Cowley RA (1982) Superiority of the femoral artery of monitoring. A prospective study. Am J Surg 144: 309–312
Mignini MA, Piacentini E, Dubin A (2006) Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study. Crit Care 10:R43
Yazigi A, Madi-Jebara S, Haddad F, Hayek G, Jawish D (2002) Accuracy of radial arterial pressure measurement during surgery under controlled hypotension. Acta Anaesthesiol Scand 46: 173–175
Kanazawa M, Fukuyama H, Kinefuchi Y, Takiguchi M, Suzuki T (2003) Relationship between aortic-to-radial arterial pressure gradient after cardiopulmonary bypass and changes in arterial elasticity. Anesthesiology 99: 48–53
Baba T, Goto T, Yoshitake A, Shibata Y (1997) Radial artery diameter decreases with increased femoral to radial arterial pressure gradient during cardiopulmonary bypass. Anesth Analg 85: 252–258
Chauhan S, Saxena N, Mehrotra S, Rao BH, Sahu M (2000) Femoral artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass. J Cardiothorac Vasc Anesth 14: 274–276
Manecke GR, Jr., Parimucha M, Stratmann G, et al (2004) Deep hypothermic circulatory arrest and the femoral-to-radial arterial pressure gradient. J Cardiothorac Vasc Anesth 18: 175–179
Rivers EP, Lozon J, Enriquez E, et al (1993) Simultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation. Crit Care Med 21: 878–883
Pauca AL, Wallenhaupt SL, Kon ND (1994) Reliability of the radial arterial pressure during anesthesia. Is wrist compression a possible diagnostic test? Chest 105: 69–75
Dorman T, Breslow MJ, Lipsett PA, et al (1998) Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients. Crit Care Med 26: 1646–1649
Arnal D, Garutti I, Perez-Pena J, Olmedilla L, Tzenkov IG (2005) Radial to femoral arterial blood pressure differences during liver transplantation. Anaesthesia 60: 766–771
Gravlee GP, Wong AB, Adkins TG, Case LD, Pauca AL (1989) A comparison of radial, brachial, and aortic pressures after cardiopulmonary by pass. J Cardiothorac Anesth 3: 20–26
Wheeler AP, Bernard GR, Thompson BT, et al (2006) Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 354: 2213–2224
Shah MR, Hasselblad V, Stevenson LW, et al (2005) Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 294: 1664–1670
Hirschl MM, Binder M, Gwechenberger M, et al (1997) Noninvasive assessment of cardiac output in critically ill patients by analysis of the finger blood pressure waveform. Crit Care Med 25: 1909–1914
de Wilde RB, Breukers RB, van den Berg PC, Jansen JR (2006) Monitoring cardiac output using the femoral and radial arterial pressure waveform. Anaesthesia 61: 743–746
Orme RM, Pigott DW, Mihm FG (2004) Measurement of cardiac output by transpulmonary arterial thermodilution using a long radial artery catheter. A comparison with intermittent pulmonary artery thermodilution. Anaesthesia 59: 590–594
Wouters PF, Quaghebeur B, Sergeant P, Van Hemelrijck J, Vandermeersch E (2005) Cardiac output monitoring using a brachial arterial catheter during off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth 19: 160–164
Smith J, Wolff C, Mills E, et al (2007) Comparison between uncalibrated cardiac output using the femoral and radial arterial pressure waveform in critically ill patients. Crit Care 11 (Suppl 2): P296 (abst)
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Smith, J., Camporota, L., Beale, R. (2009). Monitoring Arterial Blood Pressure and Cardiac Output using Central or Peripheral Arterial Pressure Waveforms. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92278-2_27
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DOI: https://doi.org/10.1007/978-0-387-92278-2_27
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