Peripheral arterial blood pressure monitoring adequately tracks central arterial blood pressure in critically ill patients: an observational study

Abstract

Introduction Invasive arterial blood pressure monitoring is a common practice in intensive care units (ICUs). Accuracy of invasive blood pressure monitoring is crucial in evaluating the cardiocirculatory system and adjusting drug therapy for hemodynamic support. However, the best site for catheter insertion is controversial. Lack of definitive information in critically ill patients makes it difficult to establish guidelines for daily practice in intensive care. We hypothesize that peripheral and central mean arterial blood pressures are interchangeable in critically ill patients. Methods This is a prospective, observational study carried out in a surgical-medical ICU in a teaching hospital. Fifty-five critically ill patients with clinical indication of invasive arterial pressure monitoring were included in the study. No interventions were made. Simultaneous measurements were registered in central (femoral) and peripheral (radial) arteries. Bias and precision between both measurements were calculated with Bland-Altman analysis for the whole group. Bias and precision were compared between patients receiving high doses of vasoactive drugs (norepinephrine or epinephrine >0.1 μg/kg/minute or dopamine >10 μg/kg/minute) and those receiving low doses (norepinephrine or epinephrine <0.1 μg/kg/minute or dopamine <10 μg/kg/minute). Results Central mean arterial pressure was 3 ± 4 mmHg higher than peripheral mean arterial pressure for the whole population and there were no differences between groups (3 ± 4 mmHg for both groups). Conclusion Measurement of mean arterial blood pressure in radial or femoral arteries is clinically interchangeable. It is not mandatory to cannulate the femoral artery, even in critically ill patients receiving high doses of vasoactive drugs.

Non-invasive detection of a femoral-to-radial arterial pressure gradient in intensive care patients with vasoactive agents

“…First, the association of FR-APG with diabetes has not been reported previously but our number of patients with a significant FR-APG is too small to identify more than one factor using logistic regression. This is, however, the largest reported study with radial and femoral artery measurements in the ICU after Mignini who included 55 patients [ 13 ] and the first reporting NIBP to estimate the FR-APG. Second, most of the patients are from a cardiac surgical intensive care unit despite the fact that there were three other medico-surgical ICU involved.…”

“…No test with enough accuracy [ 11 , 12 ] can detect a significant central to peripheral arterial pressure gradient. Furthermore, the prevalence in the ICU of a significant peripheral to central arterial pressure gradient is rarely reported [ 7 , 8 , 13 , 14 ]. As an alternative to radial invasive measurement, it has been reported that invasive and non-invasive blood pressure (NIBP) at brachial artery were higher [ 15 , 16 ] and a better reflection of aortic measurement [ 17 , 18 ].…”

Modalities of Invasive Arterial Pressure Monitoring in Critically Ill Patients

“… 16 , 17 Conversely, a large prospective study in a similar patient population showed no difference in MAP values measured by radial and femoral arterial catheters. 18 The potential influence of catheter access side has been chiefly investigated in studies of noninvasive arterial blood pressure measurement in healthy adults. Again, the, results are inconsistent, 19 – 21 and according to current guidelines either arm can be used to measure blood pressure.…”

Non-invasive detection of intracranial hypertension using a simplified intracranial hemo- and hydro-dynamics model

“…Since previous study already showed that peripheral and central mean ABPs was interchangeable [ 23 ], the SR method utilized DC trend of peripheral ABP from the index finger as the input. Furthermore, some methods also used non-invasively measured peripheral ABP for estimating ICP [ 16 , 20 ].…”