Estimation of central arterial pressure from the radial artery in patients undergoing invasive neuroradiological procedures

Sabino Scolletta,Enrico Polati,Federico Franchi,Daniel De Backer,Antoine Herpain,Salvatore Mario Romano,Katia Donadello,Boris Lubicz,Keitiane Michele Kaefer,Fabio Silvio Taccone,Jean-Louis Vincent

doi:10.1186/s12871-019-0844-1

Abstract

BackgroundsCentral arterial pressure can be derived from analysis of the peripheral artery waveform. The aim of this study was to compare central arterial pressures measured from an intra-aortic catheter with peripheral radial arterial pressures and with central arterial pressures estimated from the peripheral pressure wave using a pressure recording analytical method (PRAM).MethodsWe studied 21 patients undergoing digital subtraction cerebral angiography under local or general anesthesia and equipped with a radial arterial catheter. A second catheter was placed in the ascending aorta for central pressure wave acquisition. Central (AO) and peripheral (RA) arterial waveforms were recorded simultaneously by PRAM for 90–180 s. During an off-line analysis, AO pressures were reconstructed (AOrec) from the RA trace using a mathematical model obtained by multi-linear regression analysis. The AOrec values obtained by PRAM were compared with the true central pressure value obtained from the catheter placed in the ascending aorta.ResultsSystolic, diastolic and mean pressures ranged from 79 to 180 mmHg, 47 to 102 mmHg, and 58 to 128 mmHg, respectively, for AO, and 83 to 174 mmHg, 47 to 107 mmHg, and 60 to 129 mmHg, respectively, for RA. The correlation coefficients between AO and RA were 0.86 (p < 0.01), 0.83 (p < 0.01) and 0.86 (p < 0.01) for systolic, diastolic and mean pressures, respectively, and the mean differences − 0.3 mmHg, 2.4 mmHg and 1.5 mmHg. The correlation coefficients between AO and AOrec were 0.92 (p < 0.001), 0.87 (p < 0.001) and 0.92 (p < 0.001), for systolic, diastolic and mean pressures, respectively, and the mean differences 0.01 mmHg, 1.8 mmHg and 1.2 mmHg.ConclusionsPRAM can provide reliable estimates of central arterial pressure.

Highlights

Reliable arterial pressure monitoring is essential in critically ill patients
Romano et al showed that the function linking the central to the peripheral waveform and other variables was sufficient to be able to estimate the central arterial pressure from the pressure recorded at the radial site [17], avoiding the need to reconstruct every individual arterial wave point
Pressure Recording Analytical Method (PRAM) could be helpful in Intensive care unit (ICU) patients who are only monitored with an indwelling peripheral arterial catheter as central arterial pressures could be estimated using a continuous beat-to-beat approach

Summary

Introduction

Reliable arterial pressure monitoring is essential in critically ill patients. Physicians use the mean arterial pressure value as an index of tissue perfusion [1], but interpretation of arterial pressure waveform or derived variables is not always straightforward. Central arterial pressure can be assessed non-invasively by applanation tonometry, using a mathematical transformation (i.e., “transfer function”) to estimate the aortic pressure wave from the peripheral (i.e., brachial or radial) pulse wave [2, 12,13,14,15]. In this approach, brachial arterial pressure measurement is needed to calibrate the transfer function, and aortic blood pressure is derived taking into account the timing of both the antegrade and retrograde pulse waves [13, 14]. PRAM could be helpful in ICU patients who are only monitored with an indwelling peripheral arterial catheter as central arterial pressures could be estimated using a continuous beat-to-beat approach

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