Accuracy of radial arterial pressure measurement during surgery under controlled hypotension

Yazigi, Alexandre; Madi-Jebara, Samia; Haddad, Fadia; Hayek, G.; Jawish, D

doi:10.1034/j.1399-6576.2002.460208.x

Cited by 12 publications

(9 citation statements)

References 21 publications

(31 reference statements)

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“…It was consistent with those studies in which vasodilating therapy was beneficial to artery pressure gradient [10,11]. Normally, SVRI is seldom determined by arteries located between aorta to radial arteries.…”

Section: Discussionsupporting

confidence: 91%

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: Discussionsupporting

confidence: 91%

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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“…But other studies did not found the effect of these variables on arterial pressure gradients 22,23. Some studies have concluded that vasodilator therapy is beneficial in reducing arterial pressure gradients 24,25. Some studies have not found any significant effect of vasodilation or vasoconstriction of arterial pressure gradients 23,26.…”

Section: Discussionmentioning

confidence: 98%

Peripheral arterial blood pressure versus Central Arterial Blood Pressure Monitoring in Critically Ill Patients after Cardio-pulmonary Bypass

Ahmad

Anjum

et al. 2017

Pak J Med Sci

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Objective:To determine the accuracy of peripheral (radial) arterial access as compared to central (femoral) arterial access for measurement of invasive blood pressure (IBP) in critically ill patients after cardiopulmonary bypass.Methods:Sixty patients (60) who required high inotropic/vasopressor support on weaning from cardio-pulmonary bypass and weaned off in 2nd attempt were included in this study. The duration of this study was from June 2015 to August 2016. Radial and femoral arterial access was achieved in all patients for simultaneous measurement of blood pressure. Arterial pressures were noted after 5, 15 and 30 minutes of weaning from cardiopulmonary bypass for both radial and femoral artery simultaneously.Results:Mean age of study patients was 56.48±11.17 years. 85% patients were male. There was significant difference in systolic blood pressure, diastolic blood pressure and mean arterial pressures between the radial artery and femoral artery cannulation. Mean arterial pressures were significantly high in femoral artery as compared to the radial artery. The mean arterial pressures after five minutes of weaning using central access were 76.28±10.21 mmHg versus 64.15±6.76 mmHg in peripheral arterial access (p-value <0.001). Similarly we also found significant difference in mean arterial pressures after 15 minutes of weaning from cardiopulmonary bypass 78.70±10.12 mmHg in central access versus 72.03±6.76 mmHg using peripheral arterial access (p-value <0.001). The difference in arterial pressures were less marked as compared to the previous differences after 30 minutes of weaning from cardiopulmonary bypass as compared to the earlier readings (p-value 0.001).Conclusion:Peripheral arterial pressures are unreliable in critically ill patients after cardiopulmonary bypass receiving high dose of inotropic drugs. Central arterial access should be used in these patients to get accurate estimates of patients’ blood pressure in early periods after cardiopulmonary bypass.

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“…Arterial catheterizations are an essential tool in monitoring hemodynamically unstable patients and taking repeated blood gas samplings . Due to its comparable accuracy, lower complication rate, and lower infection incidence, the radial artery is becoming accepted as the preferred vessel for arterial catheterization over the femoral artery . Despite a lower incidence of catheter‐related bloodstream infection in the radial artery compared to the femoral, catheters that remain in a patient for more than 4 days have comparable infection rates with central venous catheters .…”

Section: Discussionmentioning

confidence: 99%

“…23,24 In these reports, the emphasis was given on the catheterization of the femoral artery to monitor central blood pressure in order to effectively, accurately, and safely administer vasoactive drugs. 20 Other investigators demonstrate that peripheral blood pressure measurements are interchangeable with central blood pressure measurements in patients that are not critically ill. 6,25 The other primary consideration is the incidence and severity of complication from the catheterization of each artery. Once again, this is an issue of debate.…”

Section: Catheterization Of the Radial Arterymentioning

confidence: 99%

Arterial Catheterization and Infection: Toll‐like Receptors in Defense against Microorganisms and Therapeutic Implications

Hambsch

Kerfeld

Kirkpatrick

et al. 2015

Clinical Translational Sci

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Radial artery catheterization has become a preferred route over femoral artery catheterization, in order to monitor the blood pressure of hemodynamically unstable patients or for repeated sampling of arterial blood gases. While the incidence of catheter-related infection is lower in the radial artery than the femoral artery, infection remains a major issue that requires attention. In this review of the literature, we discuss infectious complications of radial artery catheterization, with a focus on various risk factors and establishing the most common causative agents. We also critically review the role of the innate immune system involving Toll-like receptors (TLRs) in host-defense, with the goal of establishing a common pathway used by the innate immune system via TLRs to combat the pathogens that most commonly cause infection in radial artery catheterization. If this pathway can be therapeutically manipulated to preemptively attack pathogenic agents, immunomodulation may be an option in reducing the incidence of infection in this procedure.

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Accuracy of radial arterial pressure measurement during surgery under controlled hypotension

Abstract: Radial arterial pressure is an accurate measure of central arterial pressure during controlled hypotension achieved with arterial vasodilation.

Cited by 12 publications

References 21 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

Peripheral arterial blood pressure versus Central Arterial Blood Pressure Monitoring in Critically Ill Patients after Cardio-pulmonary Bypass

Arterial Catheterization and Infection: Toll‐like Receptors in Defense against Microorganisms and Therapeutic Implications

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