Abnormal aortic-to-radial arterial pressure gradients resulting in misdiagnosis of hemodynamic instability

Denault, André; Deschamps, Alain

doi:10.1007/s12630-009-9088-8

Cited by 20 publications

(23 citation statements)

References 4 publications

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“…However, a central-radial artery pressure gradient may happen after cardiopulmonary bypass (CPB) surgery, which in some patients may last for a significant long time after CPB. Systemic vascular resistance will be underestimated and therapeutic strategy is possible to be misleading in condition of significant artery pressure gradient [1]. To know an exact central artery pressure is very important for the anesthesiologists and the surgeons to evaluate the cardiac function, vital organ perfusion, calculate the detailed hemodynamic data and administrate corresponding vaso-active agents.…”

Section: Introductionmentioning

confidence: 99%

Central-Radial Artery Pressure Gradient after Cardiopulmonary Bypass Is Associated with Cardiac Function and May Affect Therapeutic Direction

et al. 2013

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ObjectiveTo investigate the risk factors involved in radial-femoral artery pressure gradient after cardiac surgery.MethodsIn this retrospective study, we reviewed 412 cardiac surgeries with both femoral artery pressure and radial artery pressure monitoring before cardiopulmonary bypass. 138 patients had radial-femoral artery pressure gradient after cardiopulmonary bypass (group P) but 263 were not (group N). Their hemodynamic data and other demographic data were analyzed.ResultsPhenylephrine usage was 1.7±1.1 mg in group N and 2.9±1.2 mg in group P (P<0.001). Total adrenaline usage was 229.2±116.9 µg in group N and 400.6±145.1 µg in group P (P<0.001). SBP gradient was -4±3, 14±9, 10±4, 0±11 mmHg in group P and -3±3, 0±1, -1±9, -6±4 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. DBP gradient was 3±3, -1±9, 4±5, 0±8 mmHg in group P and 3±3, 5±2, 7±5, 0±8 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. MAP gradient was 1±2, 4±6, 6±4, 0±8 mmHg in group P and 1±2, 3±1, 1±4, -2±5 mmHg in group N after induction, during discontinuation of CPB, at the end of surgery and 1 postoperative day respectively. Significant arterial pressure gradient emerged during discontinuation of CPB and at the end of surgery, which was more obvious in group P(P<0.01). CI was 2.0±0.3, 2.3±0.4,2.3±0.4, 2.2±0.4 L/min/m2 in group P and 2.1±0.3, 2.8±0.5,2.8±0.5, 2.8±0.5 L/min/m2 in group N at baseline, after discontinuation of CPB, at the end of surgery and the first postoperative day (P<0.001).ConclusionDetecting the exact central artery pressure is most important when patients have artery pressure gradients after cardiac surgery. Use inotropic agents to improve cardiac output, avoiding excessive vasoconstriction might reduce artery pressure gradient.

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Section: Introductionmentioning

confidence: 99%

Central-Radial Artery Pressure Gradient after Cardiopulmonary Bypass Is Associated with Cardiac Function and May Affect Therapeutic Direction

et al. 2013

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“…Systolic arterial pressure, when reduced in the hemodynamically unstable patient, has to be confirmed by central measurement, aortic or femoral. 34,35 This is a very important point and is illustrated in Figure 2.…”

Section: Definition Of Difficult Separation From Cpbmentioning

confidence: 95%

“…In the operating room using TEE and the intensive care unit using either TEE or transthoracic echocardiography can also be used to detect an abnormal arterial gradient when clinically significant mitral regurgitation is present. 35 Early recognition of an abnormally wide aortic-radial-arterial pressure gradient is one of the first and most important steps in recognizing true hypotension in cardiac surgery.…”

Section: Definition Of Difficult Separation From Cpbmentioning

confidence: 99%

Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass

Denault

Deschamps

Couture

2010

Semin Cardiothorac Vasc Anesth

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Every year, more than 1 million patients worldwide undergo cardiac surgery. Because of the aging of the population, cardiac surgery will increasingly be offered to patients at a higher risk of complications. The consequence is a reduced physiological reserve and hence an increased risk of mortality. These issues will have a significant impact on future health care costs because the population undergoing cardiac surgery will be older and more likely to develop postoperative complications. One of the most dreaded complications in cardiac surgery is difficult separation from cardiopulmonary bypass (CPB). When separation from CPB is associated with right-ventricular failure, the mortality rate will range from 44% to 86%. Therefore, the diagnosis and the preoperative prediction of difficult separation from CPB will be crucial to improve the selection and care of patients and to prevent complications for this high-risk patient population.

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“…After CABG and in shocked ICU patients on vasopressor agents there may be a reversed radial artery to aortic pressure gradient (systolic aortic pressure higher than radial SBP by up to 60 mmHg) [11][12][13][14]. In these patients the difference between the MAP is less than that of the SBP, however this difference may still be as large as 20 mmHg.…”

Section: Central Vs Peripheral Blood Pressure Measurementmentioning

confidence: 99%

“…Baka et al have suggested that radial artery constriction could be responsible for this pressure gradient [15]. In these patients the femoral artery is the preferred site for arterial pressure monitoring [11][12][13].…”

Section: Central Vs Peripheral Blood Pressure Measurementmentioning

confidence: 99%

Understanding the Vital Signs: BP, HR, RR, TEMP, SaO2 … and SV

Marik

2014

Evidence-Based Critical Care

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It is by no accident that the five (now six) vital signs are called VITAL SIGNS. Yet, many clinicians do not appreciate the importance of these VITAL signs nor how to interpret them. The initial assessment of every ICU and ER patient requires a thoughtful review of the five vital signs; this has an essential role in triage decisions and the initial treatment strategy. Any patient with an abnormal vital sign is at an increased risk of death. The risk of death is compounded by derangements of multiple vital signs [1]. In addition, the trends in the vital signs are VITALLY important in tracking a patient's progress. This chapter reviews the Five Vital Signs… and introduces the 6th vital sign.

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Abnormal aortic-to-radial arterial pressure gradients resulting in misdiagnosis of hemodynamic instability

Cited by 20 publications

References 4 publications

Central-Radial Artery Pressure Gradient after Cardiopulmonary Bypass Is Associated with Cardiac Function and May Affect Therapeutic Direction

Central-Radial Artery Pressure Gradient after Cardiopulmonary Bypass Is Associated with Cardiac Function and May Affect Therapeutic Direction

Intraoperative Hemodynamic Instability During and After Separation From Cardiopulmonary Bypass

Understanding the Vital Signs: BP, HR, RR, TEMP, SaO2 … and SV

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