The Fast Flush Test Measures the Dynamic Response of the Entire Blood Pressure Monitoring System

Kleinman, Bruce; Powell, Steven L.; Kumar, Pankaj; Gardner, Reed M.

doi:10.1097/00000542-199212000-00024

Cited by 84 publications

(35 citation statements)

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“…[26][27][28] After the study was approved by the institution's clinical research practices committee, written consent was obtained from 50 consecutive patients who were to undergo cardiac surgery. Patients were studied before being placed on cardiopulmonary bypass.…”

Section: Methodsmentioning

confidence: 99%

Benefit of glyceryl trinitrate on arterial stiffness is directly due to effects on peripheral arteries

Pauca

2005

Heart

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Objective: To determine how the vasodilator glyceryl trinitrate (GTN) alters arterial stiffness and improves left ventricular afterload. Methods: Ascending aortic pressure waves were measured with fluid filled catheters of high fidelity in 50 patients undergoing cardiac surgery, before cardiopulmonary bypass, both before and after intravenous infusion of GTN. In all 50 patients, wave reflection was identifiable as a secondary boost to late systolic pressure, permitting the pressure wave to be separated into a primary component, attributable to left ventricular ejection and properties of the proximal aorta, and a secondary component, attributable to reflection of the primary wave from the peripheral vasculature. Results: GTN infusion caused no change in amplitude of the primary wave (mean (SD) 0.0 (1.4) mm Hg, not significant) but substantial reduction (14.6 (9.6) mm Hg, p , 0.0001) in amplitude of the secondary reflected wave. Fall in mean pressure was attributable to a mix of arteriolar and venous dilatation, with relative contributions unable to be separated. Conclusion: Favourable effects of GTN on arterial stiffness can be attributed to effects on peripheral muscular arteries, causing reduction in wave reflection. Results conform with previous invasive studies on vasodilator agents and their known effects on calibre and compliance of muscular arteries.

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Section: Methodsmentioning

confidence: 99%

Benefit of glyceryl trinitrate on arterial stiffness is directly due to effects on peripheral arteries

Pauca

2005

Heart

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“…Frequency response and dampening coefficient were obtained by the flush method at the beginning and end of the recording period in each patient, with confirmation of natural frequency Ͼ20 Hz and dampening coefficient Ͼ0.3. 16,17 After control recordings of aortic and radial pressure waveforms were obtained over a period of at least 20 seconds, nitroglycerin (NTG) was infused intravenously at a dosage of up to 16…”

Section: Procedures and Manometric Systemmentioning

confidence: 99%

Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform

2001

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Abstract-Pressure wave reflection in the upper limb causes amplification of the arterial pulse so that radial systolic and pulse pressures are greater than in the ascending aorta. Wave transmission properties in the upper limbs (in contrast to the descending aorta and lower limbs) change little with age, disease, and drug therapy in adult humans. Such consistency has led to use of a generalized transfer function to synthesize the ascending aortic pressure pulse from the radial pulse. Validity of this approach was tested for estimation of aortic systolic, diastolic, pulse, and mean pressures from the radial pressure waveform. Ascending aortic and radial pressure waveforms were recorded simultaneously at cardiac surgery, before initiation of cardiopulmonary bypass, with matched, fluid-filled manometer systems in 62 patients under control conditions and during nitroglycerin infusion. Aortic pressure pulse waves, generated from the radial pulse, showed agreement with the measured aortic pulse waves with respect to systolic, diastolic, pulse, and mean pressures, with mean differences Ͻ1 mm Hg. Control differences in Bland-Altman plots for meanϮSD in mm Hg were systolic, 0.0Ϯ4.4; diastolic, 0.6Ϯ1.7; pulse, Ϫ0.7Ϯ4.2; and mean pressure, Ϫ0.5Ϯ2.0. For nitroglycerin infusion, differences respectively were systolic, Ϫ0.2Ϯ4.3; diastolic, 0.6Ϯ1.7; pulse, Ϫ0.8Ϯ4.1; and mean pressure, Ϫ0.4Ϯ1.8.

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“…The injection was manually performed in triplicate and the values of the transpulmonary thermodilution cardiac output were averaged. In addition, the arterial and central venous pressure transducers were zeroed and the pressure waveform signal fidelity was checked visually using a fast flush test to assess the adequacy of the damping of the arterial shape [10,11]. The site of the phlebostatic axis was defined as the zero level (reference level), which was at the intersection of the fourth intercostal space and midway between the anterior and posterior surfaces of the chest.…”

Section: Methodsmentioning

confidence: 99%

The effect of variable arterial transducer level on the accuracy of pulse contour waveform-derived measurements in critically ill patients

Liu

Long

et al. 2015

J Clin Monit Comput

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We know that a 10 cm departure from the reference level of pressure transducer position is equal to a 7.5 mmHg change of invasive hemodynamic pressure monitoring in a fluid-filled system. However, the relationship between the site level of a variable arterial pressure transducer and the pulse contour-derived parameters has yet to be established in critically ill patients. Moreover, the related quantitative analysis has never been investigated. Forty-two critically ill patients requiring PiCCO-Plus cardiac output monitoring were prospectively studied. The phlebostatic axis was defined as the zero reference level; the arterial pressure transducer was then vertically adjusted to different positions (+5, +10, +15, +20, -20, -15, -10, -5 cm) of departure from the zero reference site. The pulse contour waveform-derived parameters were recorded at each position. Elevation of the pressure transducer caused significantly positive changes in the continuous cardiac index (+CCI), stroke volume index (+SVI), and stroke volume variation (+SVV), and negative changes in the rate of left ventricular pressure rise during systole (-dP/dtmax), the systemic vascular resistance index (-SVRI), and vice versa. At the 5 cm position, the SVRI changes reached statistical significance with error. At the 10 cm position, the changes in CCI and dP/dtmax reached statistical significance with error, while the change in SVV reached statistical significance at 15 cm. The change rate of CCI was more than 5 % at the 15 cm position and approximately 10 % at the 20 cm position. On average, for every centimeter change of the transducer, there was a corresponding 0.014 L/min/m(2) CCI change and 0.36 % change rate, a 1.41 mmHg/s dP/dtmax change and 0.13 % change rate, and a 25 dyne/s/cm(5) SVRI change and 1.2 % change rate. The variation of arterial transducer position can result in inaccurate measurement of pulse contour waveform-derived parameters, especially when the transducer's vertical distance is more than 10 cm from the phlebostatic axis. These findings have clinical implications for continuous hemodynamic monitoring.

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The Fast Flush Test Measures the Dynamic Response of the Entire Blood Pressure Monitoring System

Cited by 84 publications

References 0 publications

Benefit of glyceryl trinitrate on arterial stiffness is directly due to effects on peripheral arteries

Benefit of glyceryl trinitrate on arterial stiffness is directly due to effects on peripheral arteries

Prospective Evaluation of a Method for Estimating Ascending Aortic Pressure From the Radial Artery Pressure Waveform

The effect of variable arterial transducer level on the accuracy of pulse contour waveform-derived measurements in critically ill patients

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