Download Does Radial Artery Pressure Accurately Reflect

Does Radial Artery Pressure
Reflect Aortic Pressure?*
Accurately
Aifredo
L. Pauca,
M.D.;t
Stephen
L. Wallenhaupt,
M.D.
Neal D. Kon, M.D.
F.C.C.P;1
and William
Y Tucker,
M.D.,
,
F.C.C.P1
,
Study Objective:
Our objective
was to determine
whether
the systolic,
diastolic,
and mean arterial
pressures
measured in the radial artery
accurately
reflect corresponding
pressures
in the ascending
aorta in narcotic-anesthetized
patients
with known
obstructive
coronary
artery
disease,
before being subjected
to cardiopulmonary
bypass (CPB).
Design:
This was a prospective
study.
Setting:
The cardiac
operating
room of a large,
tertiarycare university
medical
center.
Participants:
Fifty-one
patients
(45 men
and
six women;
age range, 48 to 77 years) with documented
atherosclerotic
coronary
artery
disease
were studied.
All patients
underwent elective
coronary
artery
bypass
grafting
after
the
study.
pressure
(DAP),
1.0±0.3
mm
Hg. All were significant
(p<O.O0l),
but the SAP difference
was more than ten times
that of either the MAP or the DAP values. The coefikients
of determination
(r2) indicated
that the radial-aortic
dependence
was 0.44 for the SAP, 0.90 for the DAP, and 0.98
for the MAP relationship.
Plotting the respective
differences
against
the arithmetic
mean of simultaneously
measured
pressures
indicated
that the radial SAP was 4 to 35 mm Hg
higher
than the aortic in 42 patients
(82 percent)
and was
10 to 35 mm Hg higher
in 26 patients
(51 percent);
radialaortic
MAP
differences
clustered
within
3 mm Hg in 47
patients
(92 percent);
radial DAP was ± 3 mm Hg different
from the aortic
in 46 patients
(90 percent).
The
largest
MAP difference
was
6 mm Hg in one patient.
The largest
DA.P
difference
was ± 5 mm Hg in three
patients.
Conclusions:
In this group of patients,
who were studied
before undergoing
CPB, the radial SAP gave a poor estimate
of that present
in the ascending
aorta,
since in more than
50 percent
of the cases,
the radial
SAP
was 10 to 35 mm
Hg higher
than
that
in the aorta. The radial MAP and DAP
are reliable,
since in 90 percent
and 92 percent
of the
-
-
Patients
were premedicated
with lorazepam
and morphine
60 mm before administration
of Fentanylpancuronium
anesthesia.
The radial artery was cannulated
before induction
of anesthesia
and the aorta approximately
45 mm later. Comparisons
of radial
and aortic pressures
were then performed.
Measurements
and
Results:
Radial
and aortic
pressures
were recorded
through
standard,
fluid-filled,
high-pressure, 91-cm (36-in) long tubing and disposable
transducers,
meticulously
cleared
of air bubbles.
Additional
measurements included
cardiac
output,
central
venous
pressure,
core temperature,
blood gas levels, and hematocrit
reading.
Radial-aortic
pressure
differences
were as follows: systolic
arterial
pressure
(SAP),
12 ± 1 mm Hg; mean
arterial
pressure
(MAP),
0.8 ± 0.3 mm Hg; and diastolic
arterial
Interventions:
patients,
±
respectively,
3 mm
the
Hg of those
pressure
in the
differences
(Chest
DAY
sure;
terial
diastolic
=
arterial
PVR = peripheral
pressure;
SVR
were
within
aorta.
pressure;
vascular
systemic
1992;
102:1193-98)
MAP
mean
arterial
presresistance;
SAP
systolic arvascular
resistance
-
I
n critically
major
ill
vely
to ensure
vital
organs,
Ideally,
vessels
the
patients
surgery,
that
would
perfuse
but
ery
under
aortic
Ill
fact,
*Frum
Wake
it is seldom
than
the
Departments
Forest
Medical
to measure
:1:Assistant
Professor
of Cardiothuracic
Surger
October
7, 1991; revision
waves,
while
in the
absence
expect
radial
accepted
the
pressure.
blood
higher
Stmrger
NC.
February
Departiiment
ofAnesthesia,
WinstonSalem,
North
Wake Forest
Carolina
27157-
shown
by
in dogs3
arterial
and
pressure
in awake
(SAP)
pressure
wave
humans
could
in the radial
artery
in humans
and animals’
systolic
modified
be up to
than
can
be
in the
indicates
markedly
summation
of peripherally
reflected
work in an electronic
model’#{176}shows
that
of reflected
brachio-radial
artery
tree
waves,
can
resonance
produce
of the
a considerable
difference
in radial-aortic
values
for SAP
It seems
then
that
there
is sufficient
published
evidence
indicating
that the radial SAP is not a reliable
variable
by
or severity
of blood
most
requests:
Dr. Pauca,
Medical
Center,
the
peripherally,’
except
in cases
of
or distal
shunting.2
On the other
higher
work
to
Cardiothoracic
of Anesthesia.
12.
Reprint
University
1000
been
systolic
is commonly
to the periph-
Winston-Salem,
Professor
received
it has
the
that
tAssociate
Manuscript
that
feasible
the
and
Center,
hand,
40 mm Hg
aorta.
Recent
the mean arterial
1 to 3 mm Hg
ufAnesthesia
University
of
are satisfied.
aorta
than
stenosis
the pressure
in the
or the pressure
in
it is reasonable
higher
in the
proximal
invasineeds
etc,
the radial
artery
flows from the heart
to be
undergoing
pressure
kidneys,
has been shown
that
(MAP)
is consistently
it
pressure
those
is monitored
like to know
these
organs
pressure,
pressure
in
perfusion
heart,
since
the aortic
pressure,
used.
Since blood
and
pressure
the
eg, brain,
we
that
aorta,
blood
which
to treat
patients
whose
pathology
of operation
indicates
invasive
monitoring
pressure;
however,
in our medical
center,
discussions
of the
treatment
of such
clinical
rounds
or case conferences,
SAP and diastolic
arterial
pressure
CHEST
I 102
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
center
(DAP).
I 4 I OCTOBER,
patients,
in
around
the
In order
to
1992
1193
discard
this
interviewed
thesia
in at
practice
11 senior
and surgical
least
two
institutions
years.
United
approached
ally and
prevalence
local
anachronism,
members
of our
departments
who
visiting
professorships
in the
We
as a
faculty
the
explained
of blood
first.
The
States
during
members
the
last
our interest
in finding
pressure
presentation.
surgeon,
specialist
one number
SAP One
was
reason
tradition,
simultaneous
than
after
but
artery
is sometimes
aortic
DAP,
for coronary
knowledge,
lower
on
than
and
were
uth
defiections
were
secure
this
Practices
used
to 50-s
standard
had
obstructive
being
ascending
pressures
symptoms
fraction
arch
sisted
istered
These
after
%Ve called
and
radial
lines
artery
MAP
The
by
Fentanyl
the
Preanesthetic
and
of lidocaune.
placement
of monitoring
pulmonary
Before
recorded
to
to explore
their
study.
Pancuronium
artery
induction
and
pressure
medication
(0. 1 mg/kg)
were
to 47p.g/kg)
for
times
correlated
was
the
during
primary
given
fur
or
aortic
con-
anesthetic
muscle
change
anesthesia.
at the
relaxation.
vas
electronic
the
following
80
X
in its calculation
used
(PVR)
when
the
of the
reading,
palm
ra(lial
the
during
the
SAP
period
the
radial
with
was
of
the
plotting
etc)
deemed
in agreement
differences
against
the
aspects
that
of aortic
of
and
SAP
SAP
radial
f-test
discrepancies
those
the
for
without
such
response
descriptive
Does
Artery
to
The
patient
clinically
of
the
COntrul)uted
from
the
± SEM.
mean
45 were
men,
and
The radial-aortic
Pressure
six
77 yr).
(p=0.8)
(p
following
for
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
was
calculations
as the
differences
statistics
Radial
Secundly
‘
hg
to he
in view
U LTS
48
significant.
DAP
(units)
DAP, or MAP)
differences
coefficient
and
each
studied,
range,
MAP.
For
(SAP.
([radial
employed.
4 mmii hg
expressed
are
value
was
of 10 mm
differences,
was
(radial
test
measurements.
error
three
DAP)
category
average
SAP.
than
reports.
All data
(age
statistically
aortic
of the
and
each
of their
determination
sites.
each
MAP,
within
less
previous
51 patients
women
between
pressure
I)iC55tiiC
pressure
radial
h
a measurement
view
frequency
sents
ternhematocrit
a two-sample
McNarnars
and
radial
RES
damping
also
reason.
(SAP,
plot
the
differed
radial-aortic
Of
ten
we
and
dat;i
the
the
in
were
was
of anesthesia,
saine
difference
Then
if the
technical
and
difference
differences,
temperature,
radial-aortuc
pressure
SAP]/2).hl
1)100(1
induction
were
PVR-SVR
temperature,
of hypertension
blood
SAP,
aortic
finger
and
performed.
b
one
seight,
between
DAP.
SAP
hand,
of p<O.OS
coefficients
DAP
the
For the
a history
of
we
or
coefficient)
A level
MAP.
to age.
before
ofstud
significance
SAP-aortic
f-test.
radial-aortic
MAP
SAP,
(radial-aurtic
damping
correlation
SAP,
of the
differences
patients
and
two-tailed
the
than
of data
response.
radial-aurtic
admin-
association
NIAP
Pearson
lines.
the
during
b
h
CVPJ/(X))
-
category
paired
its relationship
perattlre
oh
each
Because
group’s
cannt,latuon
possible
ol)tained
resistance
frequency
the
greater
significant
of anesthesia,
appraise
discrepancies
was
with
morphine
pressures
radial-aortic
claudication),
aortic
significant.
we considered
measure-
as those
us to
intervals
calculated
([MAP
)
within
relationships.
of
brachial
pressure
(ic,
as well
anesthesia
(25tg/kg
of the
disease
and
before
of radial
cuff
was
diastolic
allowed
identical
MAP
linearly
and
macthud
s. This
was
vascular
l)y the
calculated
First,
and
induc-
unequal
9.6
The
the
PVR-SVR,
SAP+aorta
studied
before
systolic
used.
differences
DAP,
evaluated
simultaneousl)
with
right
artery
60 mm
consisted
Patients
50 percent,
mg/kg)
recorded
The
Statistics
compared
artery
when
was
considered
51 ct)n-
were
Medical
0 to 5(X) lIz.
resistance
it peripheral
was
grafting.
Radial
or vasodilators
and
excluded.
(0.05
infiltration
1)lOOd
than
were
approximately
produced
with
of peripheral
oflorazepam
were
study.
left
They
in a thermu-
(Siemens
cami register
(dvnesscmui
it SVR
called
were
the
from
recorded
to
monitoring
and
periods.
resistance
as
Research
bypass
bypass.
support
by
ofless
calcification,
local
disease.
waveforms
the
obtained
or the
thermally
consecutive
of 30 to
restricted
formula:
The
coronary
artery
inotropic
as determined
ejection
1194
pressure
or during
ments,
was
to undergo
on cardiopulmonary
required
ofanesthesia
consent
were
coronary
placed
aortic
No patient
time
who
were
and
Gardner.
a I)erio(l
was
manufacturer
ever
of three
Vascular
history
Clinical
averaged
recording
integration.
the
to
at
whether
by the institution’s
written
patients
before
tion
was approved
Committee,
secutive
All
study
from
a nhinimum
30-s
the
it I)riiits
frequencies
categories
After
because
h
vessels,
air,
natural
before
described
great
Data
h
froni
their
determined,
procedure
the
tubing.
so labeled
Inc.)
signals
heart,
nmni in
T36AD-R).
and
within
surgical
tubes
0.9
free
standard;
sinuultaneotmslv
connecting
and
model
sere
aorta,
individual
nietictilouslv
metla)d
20-
ascemxlung
to
diameter,
were
flush
the
time
ofthe
and
inner
iii
coefficients
obtained
displacement
attached
(Spectromed
the
5. 1-cu,
approximnately
the
into
were
inercurv
h
which
Systems,
a
damping
recorder,
inserted
systems
to
through
measurements,
to transducers
comparison.
s, during
nht’asiLre(l
aortic
1 .8 mm
long,
and
each
linear
METHODS
AND
catheters
statically
catheters
the
of DAP
narcotic
anesthesia
and
lower than the aortic.
was
Both
nlea.simrung
frequencies
after
catheter
91 .4 cm
pressure
MAP,
measurement
MATERIALS
thickness
the
sere
the
For
the
these
two sites has been
done only in ten patients
in
cardiac
failure.
The
object
of this study
was to assess
whether
augmentation
of the aortic
SAP at the radial
artery
persisted
during
radial
DAP was
‘wall
avoid
when
estimating
perfusion;
however,
simultaneous
were
surgeon,
and an
that when
only
aortic,
for reasons
that are still unclear.
Additionally,
the radial
DAP is commonly
an indicator
of
required
pressure
distall
Recordings
given,
it was understood
to be
for this preference
might
rest
radial
of
that
pressures
catheters.
pointing
50
another
could
be the lack of recent,
radial-aortic
clinical
comparisons,
other
cardiopulmonary
bypass,2”2
when
the
at the
aortic
2.5
calibrated
in invasively
monitored
was being
discussed
rounds
or in anesthesia
a trauma
volunteered
Teflon
out the
We clan-
was
an orthopedic
intensive
care
and
gauge
Both
mentioned
only
in relation
to
pressures
and when
the systemic
vascular
(SVR) was deemed
important.
Interestingly,
resistance
our
two
Radial
individu-
The faculty
members
were
asked
were routinely
mentioned
and which
on special
occasions.
In 19 of 20
the SAP and DAP were presented
MAP
perfusion
SAP
participated
at teaching
faculty
fled that we were
interested
patients
when
their management
either
during
intensive
care
case conferences.
which
pressures
were
mentioned
visited
institutions,
had
we
anes-
the
Reflect
51
Aortic
=
0.4)
and
were
tal)ulation
the
not
pre-
patients:
Pressure?
(Pauca
at a!)
Table
1 -Comparison
ofRadial
Artery
and
Aortic
DAP
Pressures
difference
was
Significant
Parameter
Radial
Artery
Aorta
and
aortic
values
SAP,mmHg
111±2
99±2
SAP,
r=0.66;
DAP,mmHg
60±1
61±1
radial
and
MAP,mmHg
76±1
77±1
Vascular
resistance,
1,434
± 58 (PVR)
1,450
response,
Hz
24.8±0.6
Dampingcoefficient
± 60 (SVR)
Age,
radial
SAP,
radial
DAP,
Central
venous
pressure,
Cardiac
output,
11mm
Heart
rate,
beats
volume,
per
mm
mm
Hg
6±
65±2
comparative
data
SAP and
induction
to 111 ± 2 and
was
(p=O.000l).
12
±
Hg (p<O.OO1)
1
Radial
mm
Hg
MAP
higher
was
than SVR
to 35 mm
percent)
percent).
The
within
3 mm
-
6
from
it was
mm
was
16
±
Hg.
the aortic
was
10 to 35 mm
mm
5 dynesscm
± 4 mm
Hg,
DAP
in 46 patients
and
was
Hg
Hg
lower
(90 percent).
(51
clustered
in three
Hg
the
The
coefficients
aortic
and
of
highest
the
aortic
radial SAP
SAP, the
dependent
on the aortic
was 81 percent
dependent
a marginal
of the
relationship
radial
r
=
radial-aortic
SAP
and
existed
the
radial-
0.4,
and
r2 = 0. 19. This
SAP difference
is poorly
the actual
value
of the SAP, and this
by a patient
with a radial
SAP of 108
SAP of73 mm Hg, and identical
MAP
core
palmar
(r
temperature,
0.08
=
to
and
0. 19,
and
or finger
p>O.
tem-
1). The
radial-
aortic
pressure
of hypertension
discrepancy
in patients
with a history
was 14 ± 2 mm Hg, and that discrep-
ancy
10 ±
with no history
of hypertension
however,
the difference
between
2
in patients
mm Hg;
values
A clearer
was not
estimate
-
5
significant
of the
pressure
(
differences
was
-
of the
obtained
by
differences’4
against
(Fig 1). The mean
for the SAP, MAP, and DAP were
-7 to 31), -0.8
mm Hg (range,
± 2 SD)
(range,
to 3), and
was
the
(p = 0. 1 1).
clinical
significance
radial-aortic
pressure
of these
two pressures
differences
12 mm Hg
it was
therefore,
on the
reading,
plotting
the
the average
different
The
r=0.99;
perature
in 26 patients
patient,
and
MAP,
correlation
between
and the preanesthetic
height,
hematocrit
radial-aortic
in one
0.90.
=
radial
and DAP There
was no significant
the radial-aortic
SAP difference
SAP,
PVR,
SVR,
age,
weight,
two
± 3 mm
r
difference:
that
Radial
SAP was 4
in 42 patients
(82
radial-aontic
MAP differences
Hg in 47 patients
(92 percent);
Radial
aortic
Radial
DAP
was
aortic
(p = 0.0007).
(aortic
MAP) (p = 0.004).
Hg higher
than the aortic
and
patients,
MAP)
than
0.8±0.3
lower
than
the aortic
(p = 0.0066).
1 .0 ± 0.3 mm Hg lower than the
(radial
induction
Only
value
SAP
indicates
51 patients
after
DAP
the
dependent
on
was illustrated
mm Hg, aortic
DAP were 141 ± 3 and 69±1
of anesthesia
and decreased
60 ± 1 mm
of anesthesia.
Radial
SAP
for the
DAP,
patients.
between
radial
aortic
MAP was 98 percent
and the radial
DAP
aortic
70 ± 3
35±1
1 presents
in three
as follows:
and
and DAP, n20.81;
percent
dependent
between
0.3
4 ± 0.1
mm
aontic
on the aortic
69 ± 1
Hg
ml
studied.
Radial
mm Hg before
PVR
radial
MAP,
141 ± 3
Hg
mm
percent
Hematocrit,
The
1
81±1
Preanesthetic
Stroke
r0.98;
was 44
61.1±
kg
Preanesthetic
SAP
0.7
0.3±0.1
yr
Weight,
Table
25.0±
0.3±0.1
were
radial
Hg
(p<O.OO1)
determination,
which
indicate
the percentage
of dependence
of one parameter
upon another
(not necessanily the cause)
were as follows:
SAP, n = 0.44; MAP,
dynescm
Frequency
± 5 mm
correlations
(range,
1 .0
-
to 3), respectively.
5
40
0
C)
I
E
30
0
0
E
0
0)
1. Plot of radial-aortic
pressure
differences
against
average
of two cornpared pressures.
Solid
circles.
DAP;
squares,
MAP;
and open
circles.
SAP.
Bars from
left to right
represent
mean
(± 2 SD) of differences
in DAP,
MAP,
and SAP Notice
lack of relationship
between
radial-aortic
pressure
difference,
or error,
and
magnitude
of measured
pressures.
Note that DAP and MAP outhers are on either
side of mean
± 2 SD,
while
those
of SAP are on tipper
side.
This figure
is composite
of three
graphs
drawn
on same
units
and shows
greater
scatter
of SAP differences
against
those
of MAP and DAP
FIGURE
0
20
0
-
0
(I)
0
(0
0
ci)
0
10
0
0
0
t
0
0-
-10
0
0
0
.
0
0
:;
D
0
0
-
I
I
I
I
I
40
50
60
70
80
Average
Pressure
I
90
100
[(Radial
+
CHEST
I
110
Aorta)/2]
I 102
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
120
130
140
1992
1195
mmHg
I 4 I OCTOBER,
Although
most
difference
differences
the
± 2 SD,
and the DAP had
of the differences
Therefore,
three
did
we tested
by the McNamar’s
of 4 mm Hg or
error,
that
(p<0.0001)
the
fitted
SAP
within
and
MAP
had
the
average
aortic
two
outliers,
eluded
catheters;
wave
reflection
and the
however,
their
radial
effect
of fluid-filled
and aortic
pressure
tracings
were
These
outliers;
thus, the distribution
not fit a normal
distribution.
the significance
test.
more
ofthe
differences
By this test, when
was considered
MAP
and
DAP
differences
were
not
more
than
measurements
a difference,
4 mm
Hg,
differed
or error,’6
whereas
38
SAP
significant
vs
higher
than
the
aortic
6 Hz,
artery
pressure
through
an underdamped
tem.
The
radial
artery’s
SAP vs
Neither
comparisons
(51
in narcotic-anesthetized
pa-
tients,
shows that the radial
SAP is higher
than that of
the ascending
aorta,
as has also been
found
in dogs3
and awake
humans.4
It also confirms’
that in most
patients
the
MAP
is 1 to 3 mm
than
peripherally.
pressure
difference
in order
because
lateral
Considering
of 4 mm
to regard
of the
pressure,’7
these
effect
the
18 percent
similar
during
Hg higher
Hg
two
in the
that
a
or more
pressures
aortic
pressure
underdamped
the radial
(9) of the
cases,
aorta
radial-aortic
is required
Because
any
had
SAP
a radial
values
monitored,
(62
mm
this
of 108
Hg).
Because
finding
did
and
he
not alter
radial
The
pressure
electronic
resonant
networks
for
radial
arterial
system.
artery
1196
pressure
waveform
We
was
found
greater
we
thus
and
attempted
parameters
radial
to find
suggestive
and
distorting
the
artery
some
prescorrela-
of vascular
stiffness.
that
the radial-aortic
pressure
difference
in patients
with a history
of hypertension
not
such
statistically
a history;
significant)
that
there
than
in those
was a positive
hematocrit
MAP
was
differences
therapy
identical
was
waveforms
circuit
could
with
high
the
in
MAP
extensively
on an elecmodeled
the
axillo-brachialthat
the radial
reproduce
only
was
capable
it
is
the
only
0.19,
and
reading,
core
of distorting
the
not
possible
patients
difference.
will
to
show
Therefore,
patient
were
carried
bypass.
patients
temperature,
radial
rysm,
racic
eg,
during
however,
patients,
widest
institution
are
Thus,
with
greatest
the most
of an
factors
at present,
accuracy
which
radial-aortic
reasonable
trust
who
systolic
conduct
from
the
radial
were to undergo
these
observations
of cardiopulmonary
these
results
could
be
age groups
undergoing
resection
carotid
surgery,
the
etc,
SAP
predict
the
out before
Therefore,
in similar
with
mm Hg. There
were no
sympathetic
tone,
age,
would
be to change
our clinical
SAP to the radial
MAP
Although
we studied
patients
coronary
artery
bypass
operations,
erations,
his management,
the aorta
and
They
found
waveforms,
tions
and
reflection’3’5
tree,
aortic
an
distort
the
but in less fully monitored
patients,
these
differences
could produce
some uncertainties.
The
results
of this study
are in agreement
with
those
of Schwid
et al,’#{176}
who studied
the behavior
of
the aortic
and
tronic
model.
sure
the
that
can
atherosclerosis
arterial
between
way
system
waveform.
wave
systhe
distort
difference
had an SAP of 108
other
correlations,
although
while
Hg
the
same
is a
recorded
nation
patients
with the highest
difference
(35 mm Hg)
mm
alter
waveform
aorta,
on the aortic
was similar
in
(26) of the patients.
These
important
and could
alter
eg, one of the
systolic
pressure
the
prespressure
as dissimilar,’5
Clinically,
this means
that
the radial
MAP
reading
some patients;
radial-aortic
of
can
central
measured
catheter-manometer
oscillations
in
degree
tone
that
a
of 7 Hz
difference
and
the radial
the coefficient
of determi-
was 4 to 6 mm Hg lower than the aortic
pressure
in 8
percent
(4) of the patients,
while
the
radial
SAP
overestimated
that in the aorta by 4 to 35 mm Hg in
82 percent
(42) of the patients
and by 10 to 35 mm Hg
in 51 percent
may be very
OWfl
catheter-manometer
or any other
pressure
sympathetic
(although
without
measuring
in the
waveform
underdamped
Considering
frequency
correlation
between
this
systolic
pressure,
although
of kinetic
energy
SAP at both sites
in 92 percent
(47).
narcotic
anesthesia,
for
of that
ex-
authors’#{176}also
more
present
of SAP
DISCUSSION
conducted
artery.
a natural
reproduction
sets
similarity
study,
being
radial
with
the
resonance’#{176} in
This
stiffartery
normal
system
ours,
natural
frequency
of a normal
3 Hz and that of a stiff artery
distort
percent).
only
the
to ours.
unlike
or less’3 is unsatisfactory
sures
because
it will
waveform,
the radial
measurediffered
reached
10 mm
was 10 mm Hg or
in 26
similar
that the
lies around
model,
statistically
MAP
and
(p<O.000l).
the MAP
nor the DAP
differences
Hg; however,
the radial artery
SAP
very
This
than
the
manometer
by more than 4 mm Hg. When
of 10 mm Hg was considered
clinically
unsatisfactory,
DAP
were statistically
more
around
DAP
higher
DAP, while
different
(p = 0.083).
Only one set of MAP
ments
and four sets ofthe
DAP measurements
by
and
demonstrated
radial artery
a difference
a significant
of the
SAP
was
significantly
than that of the MAP and the
MAP
abdominal
endarterectomy,
or those
in whom
applied
major
aortic
or abdominal
vasopressors
to
opaneu-
or thoare used
major
surgery
or in the intensive
care
unit;
direct
confirmation
of these findings
in other
particularly
in those
not anesthetized,
is
required.
Although
pressure,
data,
curve;
we compared
three
differences
in blood
they belong
to three
different
categories
of
and their
therefore,
Does
Radial
distributions
statistical
Artery
Pressure
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
did not
comparison
Reflect
Aortic
follow
a normal
by analysis
of
Pressure?
(Pauca
at a!)
variance
test,
was
not
when
radial-aortic
that
the
three
and
SAP
DAP
the
in
the
radial
of the
is not
ten
since
and
although
that
DAP
the
of the
in 41 of
were
Altman’4
for
of introducing
these
results.
study,
two
where
methods
were
the
of measurement
radial
SAP
from
141 mm Hg before
111 mm Hg, a radial
SAP
be considered
to see that
considered
for
the
SAP
nor
92
(46)
was
percent
the
at least
at the
(47)
DAP
10 mm
length
122
cm
and
of the
aorta
pressure
environment.
pressure
tubing
in) to 91 cm
(36
Hz
for
a heart
Extrapolating
quency
from
from
in) and
response
would
be
10 Hz,
per
minute.
beats
per
was
for a heart
rate
of65
for
a heart
The
their pressure
respectively.
advanced
the
15 Hz
heart
rate
In two
per
minute,
measuring
It could
in our
patients
the
technology
blood
brachial-radial
resonance
aorta-radial
challenging
isolated
the
radial
minimal
central
artery
lies
frequency
pressures
micromanometer
deformed
and
response
satisfactorily
would
by the
brachial-radial
measure
to
7
that
and
measured
per
ment
during
method,
the
measurement.
the
Korotkoff
using
and
awake
DAP
values
percent
auscultatory
determines
derives
from
higher
1955
is also present
only
them
radial
to be
the
than aortic
present
in
in Fentanyl-anesthetized
findings
of clinical
signifiMAP reading
is equal
to or 3
measured
in the aorta
in 92
of the patients
the radial
DAP
in 90
in the
SAP, DAP, and MAP
subjected
to displaceThe
and
reassuring
the radial
than that
of the
are not
should
directly
sounds,
shows
that the
known
since
humans
DAP
beats
was
65±2
heart
under
correctly
of the
narcotic
measures
patients
and
anesthesia;
the aortic
differs
at most
that
50 percent
at the
of the
ascending
patients.
may
SAP,
the
but
aorta
Worst
of all,
occur
in patients
as pointed
out
with
in our
example.
rate
REFERENCES
in
27 Hz,
age of
studies
should
on the
wrist.
Arterial
2 Pauca
AL,
Mills
SA,
after
discontinuation
1989; 70:935-41
3 Hamilton
WF.
Physiol
rest,
health
Wallenhaupt
Radial
and
SL,
artery-to-aorta
disease.
patterns
Tucker
pressure
ofcardiopulmonary
The
New
bypass.
of the
arterial
WY,
Kon
difference
Anesthesiology
pressure
pulse.
Am
141:245-41
EJ,
Wood
central
exercise
AS,
et al.
1944;
recorded
in
1982:2-252
Hudspeth
ND,
J
function
Churchill-Livingstone,
5 Murgo
to measure
already
York:
MF.
E H
and
and
tilted
of
Comparison
.
peripheral
arterial
position
the
simultaneusly
pressure
in man.
Circ
pulses
during
Res
1955;
3:623-
SA.
Aortic
input
wave
forms.
32
6 Hz,’#{176}while
Thus,
1 O’Rourke
4 Kroeker
be a
of the
at the
overestimates
than
the highest
overestimation
already
borderline
radial
25 and
in this
Hz.’3
grossly
in more
minute
of9O
and
mean
method,
which
is used
monitors
(Dmnamap
model
845), determines
reliably
values,2’
provided
the cuffis
not
percent
secondly,
fre-
a waveform
resonance
size
diastolic,
also
required
is
than
patients.
The
cance
are that
mm Hg lower
minute).
reflection
3 and
pressure,
per
This
would
frequency
between
in
This study
SAP pressure
micromanombe pertinent
to
the role of the
ofwave
pressure
difference.
task,
since
the natural
systolic,
distorted
pres-
responses
be done using high-frequency
response
eters (>100
Hz). This assertion
would
our study had we attempted
to evaluate
are
by ± 5 mm Hg in 10 percent
of the cases.
On
other
hand,
the radial SAP is not only inaccurate,
the
pressure
tech-
(26 Hz for a
Shinozaki
et
rate
were
that
lateral
is of appropriate
artery.
The oscillometnic
some
commercial
automatic
the
standard
patients
systems
be argued
less
MAP
sysexceeded
beats
frequency
cuff
radial
MAP
maximum
where
measure
the
positioned,
the
meticulously
of 120 beats
values,
and
minute.
90 beats
rate
that
these
or oscillometry,
assessment
of the hemodyThese
methods,
unlike
the
cannulation,
SAP
the
by
artery
provided
radial
in order
the transducer-tubing
responses
that
these
90
as it is commonly
By decreasing
proposed
by Sykes and associates’9
rate of 180 beats
per minute)
and
al#{176}
(20
the
neither
ascending
removing
air bubbles
from
tem, we obtained
frequency
those
heart
while
frequently
used
for the
namic
state
of patients.
be
and
this magnitude.
systems
to compare
radial
(48
MAP,
auscultation
tion”3’9
and
wave
distortion
by resonance
brachial-radial
tree; and because
cuff methods
affected
by these factors,
the SAP so measured
decreased
the
Hg in error,
display
the radial
blood
monitored
in a clinical
the
the
of anesthesia
to
Hg in error
could
for
monitoring;
either
pressures
should
be unaffected
by wave summation’7
or by the brachial-radial
artery
tree
resonance.’#{176}
The main causes
of SAP deformation
are wave reflec-
to accept
of the
already
Furthermore,
the DAP reached
We used
fluid-filled
sures
had
induction
10 mm
however,
pressure
using
properly
unacceptable.
This method
allows
us
the radial
and aortic
pressures
could
be
identical
in 18 percent
(9) of the patients
SAP,
percent
has
clinical
judgment
Under
the conditions
of blood
and
very small.
The correlation
coefficients
show a much
higher
coefficient
of determination
for the MAP and
DAP values
than for SAP values.
Comparison
of the
differences
following
the
method
of Bland
and
advantage
or reject
expertise.
with the cuff methods
radial
higher
differences
This task is beyond
our present
This study was not concerned
niques,
significant;
times
surprising,
MAP
values,
indicated
highly
was
t-
of the
category,
were
aortic
paired
significance
each
difference
This
51 patients,
than
the
differences
the
MAP
Results
to assess
differences
however,
the
appropriate.
applied
a
JP,
impedance
Circulation
6 Murgo
Westerhof
N,
in normal
man:
1980;
JP,
of ascending
Vesterhof
aortic
Ciolrna
JP, Altobelli
relationship
to pressure
62: 105-16
N,
Ciolma
pressure
CHEST
and
JP, Altobelli
flow
I 102
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
wave
SA.
Manipulation
reflections
I 4 I OCTOBER,
with
1992
the
1197
Valsalva
1981;
maneuver:
7 Latham
RD,
Murgo
\Vesterhof
JP Regional
aorta:
a study
to input
Circulation
N,
wave
with
impedance.
72: 1257-69
DH
may
be a poor
guide
Circulation
left ventricular
systolic
66:323-26
1990;
9 O’Rourke
MF,
arterial
14
dilator
Schwid
the radial
artery
15
effects
measurements
Stern
DH,
direct
radial
Avolio
on central
LA,
AP,
heart
Hayward
aortic
failure.
C.
systolic
load.
Am
J
Smith
NT
Computer
pressure
monary
12
Mohr
Cerson
bypass?
Surg
response
1987;
Allen
pressure
Gcor
after
Am
17 Van
J
and
model
Clin
of
on
18
.
Direct
requirements.
Monit
DA.
cardiac
FB,
Parker
FB.
immediately
analysis
1987;
Can
we
following
1985;
62:557-61
Inaccuracy
ofradial
of
J
operations.
3:220tnmst
the
pressure
19
20
pressure
21
Anesthesiology
1981;
X
‘C
dynamic
JA,
blood
and
JC.
pinna
accuracy
of Finapres
in anesthe-
74:647-52
DS,
Treloar
indirect
AE,
and
Dobkin
direct
Circulation
Comparison
during
2nd
1972:60-106
measuremei,ts
pressure.
agreeLancet
circulation.
Inc.
The
1991;
of
Dorlas
finger
Sykes
MK,
ment.
London:
Shinozaki
Ramsey
metric
Cardiovasc
measurement:
JA.
pressure
Weatherhead
arterial
of the
Publishers.
Derr
Comparison
Vickers
AB,
methods
1954;
of
10:481-90
of plethvsrnograms
anaesthesia.
Ellestad
Cardiol
Hull
MD,
Blackwell
T, Deane
liquid-filled
22
blood
DR.
arterial
Fil,
JJ.
for assessing
measurement.
biophysics
Medical
Anesthesiology
Berger
pressure.
Thorac
Larach
mean
patients.
Nijboer
and
Book
methods
of clinical
J
Br
taken
Anaesth
1985;
57:531-34
cardiopul-
artery
RS,
catheter
devices.
NIH.
1989;
J
JE.
Monit
Reliability
The
measure-
1981:162-69
dynamic
responses
measurement
of
of blood
53:498-04
pressure
Clin
ofclinical
Publications,
for direct
1980;
Bloal
Principles
Mazuzan
systems
Anesthesiology
M III.
CJ.
Scientific
monitoring:
1991;
automated
oscillo-
7:56-67
of blood
pressure
recordings.
Am
J
63:983-85
54:227-36
XVII
1198
NM,
from
Statistical
methods
Physiology
Year
measuring
63:381-441
1989;
94:286-90
RM
AC.
tized
Effects
pressure
Cardiol
waveform.
Anesthesiology
J,
R, Lavee
measurements
13 Gardner
CI,
artery
1:307-10
on
28
11
1986;
Burton
DC.
two
noninvasive
of nitroprusside
in congestive
Altman
ed. Chicago:
pressures.
pressure
beneficial
RP,
agents
Taylor
P.
the human
JM,
between
Buckley
hydraulic
HA,
Reuderink
along
Bland
ment
16 Gibbs
artery
pressure
Kelly
left ventricular
BJ,
reflections
micromanometric
Radial
.
to the
J
Cardiol
P. Rubal
and
six simultaneous
1985;
GJ,
Sipkema
travel
Fitchett
8 Simkus
10
relationship
63:122-32
Plan to Attend ACCP’s
XVII World
Diseases
Does
Congress
on
of the Chest
Radial Artery
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21656/ on 05/12/2017
Pressure
Reflect
Aortic
Pressure?
(Pauca
et a!)