Radial artery pressure monitoring underestimates central arterial pressure during vasopressor therapy in critically ill surgical patients.
OBJECTIVE
Radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. The adequacy of the radial artery as a site for blood pressure monitoring in critically ill patients receiving high-dose vasopressors has not been carefully examined.


METHODS
Prospective observational study comparing simultaneous intra-arterial measurements of radial (peripheral) and femoral artery (central) pressures.


METHODS
Clinical investigation in a university-based surgical intensive care unit.


METHODS
Fourteen critically ill patients with presumed sepsis who received norepinephrine infusions at a rate of > or =5 microg/min.


METHODS
All patients were managed in accordance with our standard practice for presumed sepsis, which consisted of intravascular volume repletion followed by vasopressor administration titrated to a mean arterial pressure of > or =60 mm Hg.


RESULTS
Systolic and mean arterial pressures were significantly higher when measured from the femoral vs. radial site (p < .005). The higher mean arterial pressures enabled an immediate reduction in norepinephrine infusions in 11 of the 14 patients. No change in cardiac output or pulmonary artery occlusion pressure was noted after dose reduction. In the two patients in whom simultaneous recordings were made after discontinuation of norepinephrine infusions, equalization of mean arterial pressures was observed.


CONCLUSIONS
Radial artery pressure underestimates central pressure in hypotensive septic patients receiving high-dose vasopressor therapy. Clinical management, based on radial pressures, may lead to excessive vasopressor administration. Awareness of this phenomena may help minimize adverse effects of these potent agents by enabling dosage reduction.
Dorman
T
T
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Breslow
M J
MJ
Lipsett
P A
PA
Rosenberg
J M
JM
Balser
J R
JR
Almog
Y
Y
Rosenfeld
B A
BA
D015982:Bias; D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards*; D002302:Cardiac Output / Q000187:drug effects; D002496:Central Venous Pressure / Q000187:drug effects / Q000502:physiology*; D016638:Critical Illness; D016903:Drug Monitoring; D005260:Female; D005263:Femoral Artery / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D017534:Radial Artery / Q000502:physiology*; D015203:Reproducibility of Results; D012772:Shock, Septic / Q000188:drug therapy* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D014662:Vasoconstrictor Agents; D009638:Norepinephrine