title: Contribution of arterial stiffness and stroke volume to peripheral pulse pressure in ICU patients: an arterial tonometry study.
abstract: OBJECTIVE
  Peripheral arterial pulse pressure is increasingly used to assess hemodynamic status. Our aim was to test the respective influence of arterial stiffness, stroke volume, peripheral resistance, and various hemodynamic and demographic variables on peripheral pulse pressure in critically ill patients.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Medical intensive care unit of a university hospital.
  
  
  METHODS
  None.
  
  
  METHODS
  67 sinus rhythm patients (mean age 57+/-17 years) of whom 17 received vasoactive agents.
  
  
  RESULTS
  The stroke volume was calculated by Doppler echocardiography. Radial pressures were calibrated from systolic and diastolic brachial cuff pressures. Central aortic pressure was estimated by radial applanation tonometry. The arterial compliance was estimated from the aortic pressure curve using the area method and the arterial stiffness was calculated as 1/compliance. The influences of age, body surface area, arterial stiffness, stroke volume, peripheral resistance, and time intervals on peripheral pulse pressure were tested using univariate and multivariate analyses. The mean arterial pressure ranged from 42 to 113 mmHg. Peripheral pulse pressure (59+/-17 mmHg) was higher than aortic pulse pressure (40+/-14 mmHg, p<0.001). In patients aged >or= 60 years whose mean arterial pressure was >or= 80 mmHg, peripheral pulse pressure was related to arterial stiffness (r2=0.41) and to stroke volume (multiple r2 =0.90). A similar but weaker relationship was observed in the overall population (multiple r2=0.52).
  
  
  CONCLUSIONS
  In critically ill patients, and especially in aged subjects with hemodynamic stability, peripheral pulse pressure mainly reflected the combined influences of arterial stiffness and stroke volume.
authors.affiliation: Université Paris-Sud 11, Equipe d'Accueil EA4046, 94275 Le Kremlin-Bicêtre, France.
authors.forename: Bouchra
authors.initials: B
authors.lastname: Lamia
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Teboul
authors.forename: Xavier
authors.initials: X
authors.lastname: Monnet
authors.forename: David
authors.initials: D
authors.lastname: Osman
authors.forename: Julien
authors.initials: J
authors.lastname: Maizel
authors.forename: Christian
authors.initials: C
authors.lastname: Richard
authors.forename: Denis
authors.initials: D
authors.lastname: Chemla
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013318:Stroke Volume / Q000502:physiology*