Differences Between Aortic and Radial Artery Pressure Associated with Cardiopulmonary Bypass

Rich, George F.; Lubanski, Robert E.; McLoughlin, Thomas M

doi:10.1097/00000542-199207000-00009

Cited by 62 publications

(27 citation statements)

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“…We speculated that vascular properties may be different according to measuring sites in the post-CPB period, although it remains uncertain why a central-to-peripheral arterial pressure gradient occurs after CPB. [36,37] It is thought that marked arterial constriction may contribute to the damped transmission of the pressure pulse to the radial artery and intensifies discrepancy of the pressure. [38] In addition, Kanazawa et al [7] reported that central-to-peripheral arterial pressure gradient may be caused by the differences in pulse wave velocity and arterial elasticity between central and peripheral arteries.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

et al. 2016

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The maximum rate of pressure rise (dP/dtmax) in radial artery has been proposed as a noninvasive surrogate of aortic dp/dtmax, reflecting left ventricular (LV) contractility in children. The aim of this study was to investigate relationship between aortic and radial dp/dtmax at weaning from cardiopulmonary bypass (CPB) and usefulness of these indices for estimating postoperative outcomes in pediatric congenital heart surgery.Aortic and radial arterial pressure waveforms were analyzed simultaneously during weaning from CPB in 29 congenital heart surgery. The maximum first derivatives of aortic and radial arterial waveforms were calculated and averaged from 3 consecutive respiratory cycles. We obtained the maximum vasoactive inotropic score during the first 36 postoperative hours, LV ejection fraction, and fractional shortening on transthoracic echocardiography performed within postoperative day 7.A significant difference between aortic and radial dP/dtmax was observed (mean difference 356 mm Hg/s, 44% of averages), and radial dP/dtmax was weakly correlated with aortic dP/dtmax (r =0.373, P = 0.047). Aortic dP/dtmax was significantly associated with the maximum vasoactive inotropic score (P < 0.001), postoperative LV ejection fraction (P = 0.018), and fractional shortening (P = 0.015); however, radial dP/dtmax was not. On Receiver operating characteristic analysis, aortic dP/dtmax had a greater area under the curve than radial dP/dtmax in predicting higher vasoactive inotropic score (0.827 vs 0.673).Immediately after CPB in pediatric congenital heart surgery, radial dP/dtmax may not replace aortic dP/dtmax because of a discrepancy between central and peripheral arterial waveforms. In this critical period, aortic dP/dtmax can be useful to estimate postoperative ventricular function rather than peripherally derived dP/dtmax.

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Section: Discussionmentioning

confidence: 99%

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

et al. 2016

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“…The implication is that these measurements, which are intended to estimate some common underlying reality (changes in stroke volume) may be unreliable in unstable patients, in particular when taken at peripheral sites. Significant differences in central and peripheral estimates of blood pressure have been described in the hemodynamically unstable setting of post-cardiopulmonary bypass [15]. To our knowledge an investigation into the site-dependence of arterial respiratory variation has not, until now, been performed.…”

Section: Discussionmentioning

confidence: 99%

Radial–femoral concordance in time and frequency domain-based estimates of systemic arterial respiratory variation

Thiele

Colquhoun

Tucker-Schwartz

et al. 2012

J Clin Monit Comput

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Commonly used arterial respiratory variation metrics are based on mathematical analysis of arterial waveforms in the time domain. Because the shape of the arterial waveform is dependent on the site at which it is measured, we hypothesized that analysis of the arterial waveform in the frequency domain might provide a relatively site-independent means of measuring arterial respiratory variation. Radial and femoral arterial blood pressures were measured in nineteen patients undergoing liver transplantation. Systolic pressure variation (SPV), pulse pressure variation (PPV), area under the curve variation (AUCV), and mean arterial pressure variation (MAPV) at radial and femoral sites were calculated off-line. Two metrics, "Spectral Peak Ratio" (SPeR) and "Spectral Power Ratio" (SPoR) based on ratios of the spectral peak and spectral area (power) at the respiratory and cardiac frequencies, were calculated at both radial and femoral sites. Variance among radial-femoral differences was compared and correlation coefficients describing the relationship between respiratory variation at the radial and femoral sites were developed. The variance in radial-femoral differences were significantly different (p < 0.001). The correlation between radial and femoral estimates of respiratory variation were 0.746, 0.658, 0.858, 0.882, 0.941, and 0.925 for SPV, PPV, AUCV, MAPV, SPeR, and SPoR, respectively. Assuming a PPV treatment threshold of 12 % (or equivalent), differences in treatment decisions based on radial or femoral estimates would arise in 12, 14, 5.4, 5.7, 4.8, and 5.5 % of minutes for SPV, PPV, AUCV, MAPV, spectral peak ratio, and spectral power ratio, respectively. As compared to frequency domain-based estimates of respiratory variation, SPV and PPV are relatively dependent on the anatomic site at which they are measured. Spectral peak and power ratios are relatively site-independent means of measuring respiratory variation, and may offer a useful alternative to time domain-based techniques.

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“…Fourth, the large variability in temperature fluctuations secondary to active rewarming in the immediate post cardiopulmonary bypass period may have caused inaccurate physiologic data from the radial artery. This may have reflected an underestimation of actual hemodynamics derived from more central locations (femoral and brachial arteries) [5]. Mayer et al [6], have emphasized the lack of agreement between the Flotrac™/ Vigileo™ algorithm and intermittent thermodilution techniques (ITD) in the immediate post cardiopulmonary bypass period secondary to thermal changes that occur during this period.…”

Section: Discussionmentioning

confidence: 99%

Failure of the Flotrac?/Vigileo? (3.01) to Track Rapid Hemodynamic Changes in an Unstable Cardiac Surgical Patient

Ahmed¹,

Jense²,

Michałowski³

et al. 2012

J Anesthe Clinic Res

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Differences Between Aortic and Radial Artery Pressure Associated with Cardiopulmonary Bypass

Cited by 62 publications

References 0 publications

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

Radial–femoral concordance in time and frequency domain-based estimates of systemic arterial respiratory variation

Failure of the Flotrac?/Vigileo? (3.01) to Track Rapid Hemodynamic Changes in an Unstable Cardiac Surgical Patient

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