Abstract
In standard critical care practice, cuff sphygmomanometry is widely used for intermittent blood pressure (BP) measurements. However, cuff devices offer ample possibility of modulating blood flow and pulse propagation along the artery. We explore underutilized arrangements of sensors involving cuff devices which could be of use in critical care to reveal additional information on compensatory mechanisms. In our previous work, we analyzed the response of the vasculature to occlusion perturbations by means of observations obtained non-invasively. In this study, our aim is to (1) acquire additional insights by means of invasive measurements and (2) based on these insights, further develop cuff-based measurement strategies. Invasive BP experimental data is collected downstream from the cuff in two patients monitored in the OR. It is found that highly dynamic processes occur in the distal arm during cuff inflation. Mean arterial pressure increases in the distal artery by 20 mmHg, leading to a decrease in pulse transit time by 20 ms. Previous characterizations neglected such distal vasculature effects. A model is developed to reproduce the observed behaviors and to provide a possible explanation of the factors that influence the distal arm mechanisms. We apply the new findings to further develop measurement strategies aimed at acquiring information on pulse arrival time vs. BP calibration, artery compliance, peripheral resistance, artery-vein interaction.
Highlights
IntroductionIn standard hemodynamic monitoring practice, the cuff measurement principle consists of altering the transmural pressure across the brachial arterial wall; the resulting brachial arterial volume oscillations are measured and interpreted via an empirical method to estimate blood pressure (BP)
Our data shows that large blood pressure (BP) changes occur due to cuff inflation
We quantify the decrease in ∆PTTABP− PPG (Figure 7(1A,2A) for all cuff inflations performed on Patient1 and Patient2, respectively
Summary
In standard hemodynamic monitoring practice, the cuff measurement principle consists of altering the transmural pressure across the brachial arterial wall; the resulting brachial arterial volume oscillations are measured and interpreted via an empirical method to estimate blood pressure (BP). A hypothesis is that the cuff is underutilized in clinical practice and that other measurement strategies can be developed based on occlusion-based modulation of flow and pulse propagation along the artery, in combination with standard monitoring equipment (e.g., electrocardiogram ECG, photoplethysmogram PPG). For this reason, in our previous work we explored how to adapt the cuff measurement principle to obtain further information, in addition to the intermittently acquired BP values.
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