Arterial site selection for measurement of mean arterial pressure in septic shock patients on high-dose norepinephrine

Abstract

BackgroundThe guidelines of the Surviving Sepsis Campaign suggest using invasive blood pressure (IBP) measurement in septic shock patients, without specifying for a preferred arterial site for accuracy in relation to the severity of septic shock. The objective of this study was to determine the mean arterial pressure (MAP) gradient between the femoral and radial artery sites in septic shock patients.MethodThis prospective study was carried out at a 20-bed ICU in a university hospital. Simultaneous MAP measurements at femoral and radial arterial sites were obtained in septic shock patients receiving norepinephrine (≥0.1 μg/kg/min), with a pre-planned subgroup analysis for those receiving a high dose of norepinephrine (≥0.3 μg/kg/min).ResultsThe median norepinephrine dose across all 80 patients studied, including 59 patients on a high dose, was 0.4 (0.28–0.7) μg/kg/min. Overall, simultaneous measurement of MAP (mmHg) at the femoral and radial arterial sites produced mean (95% CI) MAP values of 81 (79–83) and 78 (76–80), respectively, with a mean difference of 3.3 (2.67–3.93), p < 0.001. In Bland–Altman analysis of MAP measurements, the detected effect sizes were 1.14 and 1.04 for the overall and high-dose cohorts, respectively, which indicates a significant difference between the measurements taken at each of the two arterial sites. The Pearson correlation coefficient indicated a weak but statistically significant correlation between MAP gradient and norepinephrine dose among patients receiving a high dose of norepinephrine (r = 0.289; p = 0.026; 95% CI 0.036–0.508).ConclusionIn septic shock patients, MAP readings were higher at the femoral site than at the radial site, particularly in those receiving a high dose of norepinephrine.Clinical trial registration[ClinicalTrials.gov], identifier [NCT03475667].

Comparison of Central and Peripheral Arterial Blood Pressure Gradients in Critically Ill Patients: A Systematic Review and Meta-Analysis

“…The basic features of the included studies are summarized in Table 1; and Supplemental Table 2 (http:// links.lww.com/CCX/B343). The earliest article was published in 1987 (29), and the latest article was published in 2022 (6)(7)(8). Twenty-three studies compared the femoral artery with the radial artery, whereas one study compared the femoral artery with the brachial artery.…”

“…Earlier studies have shown variable results regarding the concordance of blood pressure readings from different arterial sites in high-risk surgical and critically ill patients. Some studies found a good correlation between these measurements, while others observed genuine differences in systolic blood pressure (SBP) and mean arterial pressure (MAP) between central and peripheral sites (6–29). This disparity has the potential to influence clinical decision-making and patient outcomes as the accuracy of invasive blood pressure monitoring is crucial in determining the stability of the circulatory system, perfusion to major organs and hence guide the need for interventions.…”