Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

Romagnoli, Stefano; Ricci, Zaccaria; Quattrone, Diego; Tofani, Lorenzo; Tujjar, Omar; Villa, Gianluca; Romano, Salvatore Mario; Gaudio, Angelo Raffaele De

doi:10.1186/s13054-014-0644-4

Cited by 145 publications

(111 citation statements)

References 25 publications

(50 reference statements)

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“…There is, however, ample evidence suggesting that non-invasively measured MAP is a better indicator of invasive blood pressure than non-invasive systolic blood pressure alone (45–47). While to solve this partial discrepancy is beyond the scope of this study, it has been shown recently that the difference of NIBP and invasive arterial blood pressure is clinically negligible in both adults and children with few exceptions (48,49); NIBP continues to be widely used by ICU physicians (50), and NIBP is proportional to intravascular volume during hemorrhage (12). It is furthermore readily and feasibly available to professionals of all levels of experience and causes few complications (51).…”

Section: Discussionmentioning

confidence: 99%

Closed-Loop– and Decision-Assist–Guided Fluid Therapy of Human Hemorrhage*

Hundeshagen

Kramer

Marques

et al. 2017

Critical Care Medicine

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Objectives We sought to evaluate the efficacy, efficiency and physiological consequences of automated, end-point directed resuscitation systems and compare them to formula-based bolus resuscitation. Design Experimental human hemorrhage and resuscitation Setting Clinical Research Laboratory Subjects Healthy volunteers Interventions Subjects (n=7) were subjected to hemorrhage and underwent a randomized fluid resuscitation scheme on separate visits 1) formula-based bolus resuscitation (BR) 2) semi-autonomous (decision-assist, DA) fluid administration and 3) fully autonomous (closed-loop, CL) resuscitation. Hemodynamic parameters, volume shifts, fluid balance, and cardiac function were monitored during hemorrhage and resuscitation. Treatment modalities were compared based on resuscitation efficacy and efficiency. Measurements and Main Results All approaches achieved target BP by 60 min. Following hemorrhage, the total amount of infused fluid (BR: 30ml/kg, DA: 5.6±3 ml/kg, CL: 4.2±2ml/kg, p<0.001), plasma volume, extravascular volume (BR: 17±4ml/kg, DA: 3±1ml/kg, CL: -0.3±0.3ml/kg, p<0.001), body weight and urinary output remained stable under DA and CL and were significantly increased under bolus resuscitation. Mean arterial pressure initially decreased further under bolus resuscitation (-10mmHg, p<0.001) and was lower under BR than CL at 20min (BR: 57±2mmHg CL: 69±4mmHg, p=0.036). Colloid-osmotic pressure (BR: 19.3±2mmHg DA, CL: 24±0.4mmHg, p<0.05) and hemoglobin concentration were significantly decreased after bolus fluid administration. Conclusions We define efficacy of decision-assist and closed-loop resuscitation in human hemorrhage. In comparison to formula-based bolus resuscitation, both semiautonomous and autonomous approaches were more efficient in goal-directed resuscitation of hemorrhage. They provide favorable conditions for the avoidance of over-resuscitation and its adverse clinical sequelae. Decision-assist and closed-loop resuscitation algorithms are promising technological solutions for constrained environments and areas of limited resources.

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Section: Discussionmentioning

confidence: 99%

Closed-Loop– and Decision-Assist–Guided Fluid Therapy of Human Hemorrhage*

Hundeshagen

Kramer

Marques

et al. 2017

Critical Care Medicine

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“…In addition to the natural frequency of the catheter system, the other parameter that determines the fidelity of the recorded signal is the damping coefficient. Under-damping can lead to falsely high systolic pressures and resonant ringing of the pressure pulse [2], while over-damping will conversely lead to diminution of the amplitude, loss of details like the dicrotic notch in addition to falsely low systolic pressures.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, no two consecutive pressure cycles have the same systolic and diastolic blood pressures and the concept of beat to beat variability is well-established. Such variations in systolic and diastolic pressures can be appreciated best in an intra-arterial recording using a fluid-filled catheter connected to a pressure transducer, which being a direct measurement of the pressure in the artery may be considered the gold standard for BP measurements [2], provided care is taken to avoid measurement errors due to air-bubbles, blood clots and compliance of the tube in the catheter system. Intra-arterial BP is an invasive method and it is not possible to perform measurements with invasive techniques in routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure variability from intra-arterial recordings in humans

Mukadam

Gangadharan

Baskaran

et al. 2019

Preprint

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Systolic and diastolic blood pressures are reported as single point values by the non-invasive techniques used in clinical practice, while, in fact, they are highly varying signals. The objective of this study was to document the magnitude of variation of systolic and diastolic pressures over a few minutes by analysing intra-arterial pressure recordings made in 51 haemodynamically stable patients in an intensive care unit. Intra-arterial pressure data were acquired by a validated data acquisition system. Fast-Flush test was performed and the dynamic characteristics of the catheter transducer system namely natural frequency and damping coefficient were calculated. Only those recordings with acceptable dynamic characteristics were included in the analysis. Power spectral calculation using the Discrete Fourier transform (DFT) of the pressure recording revealed two frequency peaks below the peak at heart rate. The lower and higher frequency peaks below the heart rate peak are referred to as Mayer and Traube waves in this study. Mayer wave peaks were observed in DFT spectra of 49 out of 51 patients.The Mayer wave frequency peaks ranged between 0.045 Hz to 0.065 Hz in 41 out of 51 patients. The frequency of Traube waves or the respiratory variations was more than 0.14 Hz.Three categories of systolic and diastolic pressure variabilities namely beat-to-beat variability, Respiratory variability (Traube wave amplitude) and Total magnitude of variation are reported for all 51 patients. The mean systolic and diastolic pressure variations (in a period of about 10 minutes) in the study sample were 21 ± 9 mmHg and 14 ± 5 mmHg respectively. Given the magnitude of systolic and diastolic pressure variations over a few minutes, the validity of reporting single point values for these pressures and using single point cut offs for diagnosis and treatment of hypertension must be re-evaluated.

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“…All these values are automatically averaged over a 30-second period, as recommended by the manufacturer. To avoid the risk of underdamping or overdamping of the arterial pressure signal and avert the consequent inaccurate determinations, we performed the square wave test in all patients before initiating the study protocol [24]. The hemodynamic data recorded by PRAM ® were transferred on a data card and then exported into a spreadsheet through dedicated software (MOSTCARE Data Card Reader 4.0.11).…”

Section: Protocolmentioning

confidence: 99%